Association of Serum Uric Acid with Cardiovascular-Kidney-Metabolic Syndrome in Elderly Populations: Results from Chinese and US cohorts

Background Cardiovascular-kidney-metabolic (CKM) syndrome is highly prevalent among the elderly. Serum uric acid (SUA) may serve as a potential marker for CKM,but evidence on the association between SUA levels and the progression of CKM syndrome remains scarce and controversial. This study aims to investigate the relationship between SUA levels and CKM syndrome in elderly populations by utilizing cohort data from China and the United States. Methods We analyzed 3,299 participants from the Shanghai Friendship Community Elderly Cohort (SFCEC) and 2,372 from the US National Health and Nutrition Examination Survey (NHANES) 2011–2018.SUA was measured using standardized assays. Multivariate logistic regression models were performed. Restricted cubic spline regression was performed to visualize the dose-response relationship. Results The prevalence of CKM syndrome (stages 1–4) was strikingly high in both elderly cohorts(98.33% in the SFCEC cohort and 98.76% in the NHANES cohort). After comprehensive adjustment, multivariable analysis revealed that each 1 mg/dl increase in serum uric acid was associated with 24.9% (OR = 1.249, 95% CI: 1.186–1.315) and 27.8% (OR = 1.278, 95% CI:1.174–1.392) elevated risks of CKM syndrome in the Shanghai and US cohorts, respectively. Compared with the lowest tertile, participants in the highest serum uric acid tertile demonstrated significantly increased CKM risks (Shanghai cohort: OR = 1.966, 95% CI: 1.653–2.339; US cohort: OR = 1.975, 95% CI:1.472–2.650). Restricted cubic spline analysis indicated a positive linear dose-response relationship between serum uric acid levels and CKM syndrome staging. This association was more pronounced in female patients. Conclusions This study reveals that elevated SUA levels may be a potential independent risk factor for the progression of CKM syndrome in the elderly population.Clinical screening of SUA levels may be helpful for the early detection and prevention of CKM syndrome.