Song Fei, Hu Meng-Jin, Xia Jinggang, Yin Chunlin
Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China.
Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
Open Heart. 2025 Aug 18;12(2):e003395. doi: 10.1136/openhrt-2025-003395.
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome plays a critical role in the pathogenesis of cardiovascular diseases (CVD). Growing evidence has established that impaired intrinsic capacity (IC) served as a robust predictor of adverse health outcomes. However, its specific association with incident CVD in CKM syndrome populations has not been established. METHODS: The China Health and Retirement Longitudinal Study is a nationally representative cohort study in China. First, the relationship between baseline IC and the incidence of CVD was analysed using Cox regression models. Subsequently, subgroup and interaction analyses were conducted among different groups. To investigate the potential non-linear relationship between baseline IC and CVD risk, restricted cubic spline (RCS) regression of HR was employed. Furthermore, IC trajectories over time were analysed using group-based trajectory modelling. The associations of the trajectory memberships with CVD risk were analysed using logistic regression models. RESULTS: Among 5346 participants included, of whom 2712 (50.7%) were men and 2634 (49.3%) were women, with a mean age of 57.3 (9.02) years. The results of the fully adjusted Cox regression analyses indicated that there was an 8% decrease in risk for every 1-score rise in IC (HR=0.92, 95% CI: 0.87 to 0.98). The RCS regression analyses demonstrated a linear association between baseline IC and CVD risk in the CKM syndrome population. Subgroup and interaction analyses showed no interactions observed in any subgroups. Trajectory analysis identified three longitudinal patterns of IC with age: class 1, 'low level' (12%); class 2, 'medium level' (25%); class 3, 'high level' (63%). Logistic regression models indicated that both 'low level' and 'medium level' IC trajectories were independently associated with significantly higher CVD risk compared with the 'high level' reference group. CONCLUSIONS: This prospective cohort study demonstrated significant associations between both baseline IC and its longitudinal changes with incident CVD risk among individuals with CKM syndrome stages 0-3.
背景：心血管-肾脏-代谢（CKM）综合征在心血管疾病（CVD）的发病机制中起关键作用。越来越多的证据表明，内在能力（IC）受损是不良健康结局的有力预测指标。然而，其与CKM综合征人群中CVD发病的具体关联尚未明确。 方法：中国健康与养老追踪调查是一项具有全国代表性的队列研究。首先，使用Cox回归模型分析基线IC与CVD发病率之间的关系。随后，在不同组间进行亚组分析和交互作用分析。为了研究基线IC与CVD风险之间潜在的非线性关系，采用了HR的受限立方样条（RCS）回归。此外，使用基于组的轨迹模型分析IC随时间的轨迹。使用逻辑回归模型分析轨迹类别与CVD风险的关联。 结果：纳入的5346名参与者中，男性2712名（50.7%），女性2634名（49.3%），平均年龄57.3（9.02）岁。完全调整后的Cox回归分析结果表明，IC每升高1分，风险降低8%（HR=0.92，95%CI：0.87至0.98）。RCS回归分析表明，CKM综合征人群中基线IC与CVD风险呈线性关联。亚组分析和交互作用分析显示，在任何亚组中均未观察到交互作用。轨迹分析确定了IC随年龄变化的三种纵向模式：第1类，“低水平”（12%）；第2类，“中等水平”（25%）；第3类，“高水平”（63%）。逻辑回归模型表明，与“高水平”参考组相比，“低水平”和“中等水平”的IC轨迹均与显著更高的CVD风险独立相关。 结论：这项前瞻性队列研究表明，在0-3期CKM综合征个体中，基线IC及其纵向变化与CVD发病风险均存在显著关联。
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