Associations of Cardiovascular-Kidney-Metabolic Syndrome with Premature Mortality and Life Expectancies in US Adults: A Cohort Study
Lubi Lei, Jingkuo Li, Wenbo Ding, Wei Wang, Yanwu Yu, Boxuan Pu, Yue Peng, Lihua Zhang, Yuan‐Lin Guo
Abstract
BACKGROUND: The American Heart Association has recently updated the Cardiovascular-Kidney-Metabolic (CKM) Health Advisory, proposing a new framework for defining, staging, and predicting CKM risk. However, the prevalence and adverse effects of the CKM stages remain insufficiently characterized. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) (1999-2018), including 18,350 US adults aged 20-79 years. CKM syndrome encompasses subclinical or clinical cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic risk factors. The participants were categorized into 4 CKM stages based on their clinical severity. We assessed associations of CKM stages with mortality risk and life expectancy. RESULTS: Only 12.9% of participants were classified as having CKM stage 0. The prevalence of CKM stages 1, 2, 3, and 4 was 23.1%, 53.6%, 3.6%, and 6.7%, respectively. Compared with CKM stage 0, individuals in stage 4 had a markedly higher risk of all-cause mortality (HR: 4.30, 95% CI: 2.95-6.26) and lost 15.5 (12.5-19.8) years of life at age 50 years. Sex and racial/ethnic disparities were also observed. CONCLUSIONS: A higher CKM stage was strongly associated with increased mortality and reduced life expectancy. Our findings underscore the urgent need for enhanced CKM health management, social support, and policy intervention.