晚期心血管-肾脏-代谢综合征的发病年龄与死亡率梯度之间的关联。

Association between onset age and mortality gradients in advanced cardiovascular-kidney-metabolic syndrome.

作者信息

Dai Jinjin, Wu Chuanchang, Liu Shihua, Chen Shuohua, Hong Xiaodan, Zhang Pengyue, Cui Liufu, Wu Shouling, Zhang Zhenhua

机构信息

Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.

Department of Infectious Diseases, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China.

出版信息

Front Endocrinol (Lausanne). 2025 Sep 3;16:1648083. doi: 10.3389/fendo.2025.1648083. eCollection 2025.

DOI:10.3389/fendo.2025.1648083

PMID:40969377

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12440721/

Abstract

INTRODUCTION

Advanced cardiovascular-kidney-metabolic (A-CKM) syndrome portends severe prognosis, but how onset age affects mortality risk remains unquantified.

METHODS

This study analyzed 179,328 participants from the Kailuan cohort in Tangshan, China (2006-2022). Using weighted Cox models and stratified analyses, we assessed the association of age at onset with all-cause mortality risk.

RESULTS

Among 17,283 incident A-CKM cases matched to age-stratified controls, early-onset patients (<45 y) had the highest relative mortality risk (HR = 3.35), which was amplified by smoking (HR = 5.27) and inflammation (hsCRP≥3mg/L: HR = 10.15); midlife onset (45- 54 y) represented the optimal prevention window (NNT = 15), yet with extreme female vulnerability (Stage 4 HR=14.25 vs. male HR=2.54); late-adulthood onset (55-64y) incurred peak absolute burden (ΔRate +8.61/1000PY), while elderly cases (≥65 y) had an attenuated attributable impact despite higher mortality (33.95 vs. 2.48/1000 PY).

DISCUSSION

These findings support an age-stratified management framework: core age phased priorities (risk containment <45 y, preventive interception 45 - 54 y, complication management 55 - 64 y, and renoprotective optimization ≥65 y) augmented by sex-specific refinements-aggressive inflammation control in young men and intensified midlife monitoring for women-resolving the efficiency-burden paradox through calibrated implementation.

CLINICAL TRIAL REGISTRATION

https://www.chictr.org.cn/showproj.html?proj=8050, identifier ChiCTR-TNRC-11001489.

摘要

引言

晚期心血管-肾脏-代谢（A-CKM）综合征预示着严重的预后，但发病年龄如何影响死亡风险仍未得到量化。

方法

本研究分析了来自中国唐山开滦队列（2006 - 2022年）的179,328名参与者。使用加权Cox模型和分层分析，我们评估了发病年龄与全因死亡风险之间的关联。

结果

在17,283例与年龄分层对照匹配的A-CKM发病病例中，早发型患者（<45岁）的相对死亡风险最高（HR = 3.35），吸烟（HR = 5.27）和炎症（hsCRP≥3mg/L：HR = 10.15）会使其风险进一步增加；中年发病（45 - 54岁）代表了最佳预防窗口（NNT = 15），但女性特别脆弱（4期HR = 14.25，男性HR = 2.54）；成年晚期发病（55 - 64岁）带来的绝对负担峰值最高（ΔRate +8.61/1000PY），而老年病例（≥65岁）尽管死亡率较高，但归因影响减弱（33.95对2.48/1000 PY）。