Li Jiangtao, Wei Xiang
Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, PR China.
Am J Prev Cardiol. 2025 Mar 29;22:100985. doi: 10.1016/j.ajpc.2025.100985. eCollection 2025 Jun.
Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.
Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.
Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.
Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.
鉴于合并症风险因素所带来的心血管疾病（CVD）风险的相关证据，美国心脏协会（AHA）最近引入了一种新的分期概念，即心血管-肾脏-代谢（CKM）综合征。本研究调查了美国成年人中CKM综合征各阶段与全因死亡率和心血管死亡率之间的关联。
数据来自1999 - 2018年国家健康与营养检查调查（NHANES）基线数据，并与2019年国家死亡指数记录相链接。对于每位参与者，CKM综合征被分为五个阶段：0期（无CKM风险因素）、1期（肥胖过多或功能失调）、2期（代谢风险因素和慢性肾脏病）、3期（亚临床CVD）或4期（临床CVD）。主要结局为全因死亡率和心血管死亡率。
在34,809名参与者中（平均年龄：46.7岁；男性：49.2%），CKM 0至4期的患病率分别为13.2%、20.8%、53.1%、5.0%和7.8%。在中位随访8.3年期间，与CKM 0期的参与者相比，更高阶段的参与者全因死亡风险增加（2期：HR 1.43，95% 1.13 - 1.80；3期，HR 2.75，95% CI 2.12 - 3.57；4期，HR 3.02，95% CI 2.35 - 3.89）。心血管死亡风险的相应风险比（95%置信区间）分别为2.96（1.39 - 6.30）、7.60（3.50 - 16.5）和10.5（5.01 - 22.2）。晚期（3期或4期）与CKM综合征各阶段（0期、1期或2期）相比，全因死亡率的人群归因分数为25.3%，心血管死亡率的人群归因分数为45.3%。
更高的CKM综合征阶段与全因死亡率和心血管死亡率风险增加相关。这些发现强调应加强促进CKM健康的一级预防和初级预防措施，以降低死亡风险。
