Kim Byung Sik, Kim Hyun-Jin, Kim Hasung, Lee Jungkuk, Shin Jeong-Hun, Sung Ki-Chul
Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea.
Data Science Team, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea.
J Clin Med. 2025 Jun 1;14(11):3888. doi: 10.3390/jcm14113888.
The impact of longitudinal changes in cardiovascular-kidney-metabolic (CKM) stage remains unclear. This study evaluated the association between CKM stage progression and clinical outcomes. : We used the Korean National Health Insurance Database to identify adults aged ≥ 20 years who underwent two health checkups between 2009 and 2012. CKM stages were assessed at both time points and categorized as decreased, maintained, or increased over a 1-2-year interval. The primary outcome was a composite of all-cause death, heart failure, stroke, and myocardial infarction, evaluated over a mean follow-up of 11.05 years. : Among 877,537 participants, 15.3% experienced CKM stage progression. Compared to the maintained group, the increased group had a higher risk of the composite outcome (HR: 1.071, 95% CI: 1.050-1.092). While men had a higher rate of progression, women showed greater risk of clinical events (HR: 1.124 vs. 1.040). While stage progression was more frequent in younger adults, older individuals in the increased group progressed to more advanced stages and experienced higher rates of adverse outcomes. : CKM stage progression is independently associated with increased risk of mortality and cardiovascular events, particularly in women and older adults. Serial CKM assessment may help identify high-risk individuals for early intervention.
心血管-肾脏-代谢（CKM）阶段的纵向变化所产生的影响仍不明确。本研究评估了CKM阶段进展与临床结局之间的关联。我们利用韩国国民健康保险数据库，确定了在2009年至2012年期间接受过两次健康检查的20岁及以上成年人。在两个时间点均对CKM阶段进行了评估，并将其在1至2年的时间间隔内分类为下降、维持或上升。主要结局是全因死亡、心力衰竭、中风和心肌梗死的综合情况，在平均11.05年的随访期内进行评估。在877,537名参与者中，15.3%经历了CKM阶段进展。与维持组相比，进展组发生综合结局的风险更高（风险比：1.071，95%置信区间：1.050 - 1.092）。虽然男性的进展率更高，但女性发生临床事件的风险更大（风险比：1.124对1.040）。虽然年轻人中阶段进展更为频繁，但进展组中的老年人进展到更高级阶段并经历了更高的不良结局发生率。CKM阶段进展与死亡风险和心血管事件增加独立相关，尤其是在女性和老年人中。连续进行CKM评估可能有助于识别高危个体以便进行早期干预。
