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. 2023 Nov 1;8(11):1050-1060.
doi: 10.1001/jamacardio.2023.3241.

Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020

John W Ostrominski  1 , Suzanne V Arnold  2 , Javed Butler  3   4 , Gregg C Fonarow  5 , Jamie S Hirsch  6 , Swetha R Palli  7 , Bonnie M K Donato  7 , Christina M Parrinello  8 , Thomas O'Connell  9 , Eric B Collins  10 , Jonathan J Woolley  9 , Mikhail N Kosiborod  2 , Muthiah Vaduganathan  1
Affiliations

Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020

John W Ostrominski et al. JAMA Cardiol. .

Abstract

Importance: Individually, cardiac, renal, and metabolic (CRM) conditions are common and leading causes of death, disability, and health care-associated costs. However, the frequency with which CRM conditions coexist has not been comprehensively characterized to date.

Objective: To examine the prevalence and overlap of CRM conditions among US adults currently and over time.

Design, setting, and participants: To establish prevalence of CRM conditions, nationally representative, serial cross-sectional data included in the January 2015 through March 2020 National Health and Nutrition Examination Survey (NHANES) were evaluated in this cohort study. To assess temporal trends in CRM overlap, NHANES data between 1999-2002 and 2015-2020 were compared. Data on 11 607 nonpregnant US adults (≥20 years) were included. Data analysis occurred between November 10, 2020, and November 23, 2022.

Main outcomes and measures: Proportion of participants with CRM conditions, overall and stratified by age, defined as cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), or all 3.

Results: From 2015 through March 2020, of 11 607 US adults included in the analysis (mean [SE] age, 48.5 [0.4] years; 51.0% women), 26.3% had at least 1 CRM condition, 8.0% had at least 2 CRM conditions, and 1.5% had 3 CRM conditions. Overall, CKD plus T2D was the most common CRM dyad (3.2%), followed by CVD plus T2D (1.7%) and CVD plus CKD (1.6%). Participants with higher CRM comorbidity burden were more likely to be older and male. Among participants aged 65 years or older, 33.6% had 1 CRM condition, 17.1% had 2 CRM conditions, and 5.0% had 3 CRM conditions. Within this subset, CKD plus T2D (7.3%) was most common, followed by CVD plus CKD (6.0%) and CVD plus T2D (3.8%). The CRM comorbidity burden was disproportionately high among participants reporting non-Hispanic Black race or ethnicity, unemployment, low socioeconomic status, and no high school degree. Among participants with 3 CRM conditions, nearly one-third (30.5%) did not report statin use, and only 4.8% and 3.0% used glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, respectively. Between 1999 and 2020, the proportion of US adults with multiple CRM conditions increased significantly (from 5.3% to 8.0%; P < .001 for trend), as did the proportion having all 3 CRM conditions (0.7% to 1.5%; P < .001 for trend).

Conclusions and relevance: This cohort study found that CRM multimorbidity is increasingly common and undertreated among US adults, highlighting the importance of collaborative and comprehensive management strategies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Butler reported receiving personal fees from Abbott, American Regent, Amgen, Applied Therapeutic, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiac Dimension, Cardior, CVRx, Cytokinetics, Edwards, Element Science, Innolife, Impulse Dynamics, Imbria, Inventiva, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Roche, Sequana, SQ Innovation, and Vifor. Dr Fonarow reported receiving personal fees from Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Eli Lilly, Janssen, Medtronic, Merck, Novartis, and Pfizer outside the submitted work; and serving as an associate section editor for JAMA Cardiology. Dr Hirsch reported receiving personal fees from Boehringer Ingelheim outside the submitted work. Ms Palli reported being employed by Boehringer Ingelheim, which has a product indicated for managing cardiac, renal, and metabolic conditions, during the conduct of the study. Dr Donato reported being employed by Boehringer Ingelheim, which has a product indicated for managing CRM conditions. Dr Parrinello reported receiving personal fees from Medicus Economics during the conduct of the study; personal fees from Medicus Economics, Collective Acumen, ConcertAI, EQRx, Evidation Health, Canopy Care, Flatiron Health, Greenleaf Health, Jazz Pharmaceuticals, Sensorum Health, TTi Health Research & Economics, and Clue by Biowink outside the submitted work. Messrs O’Connell, Collins, and Woolley are employees of Medicus Economics, a health economics and outcomes research consultancy that received consulting fees from Boehringer Ingelheim during the course of the study and have received consulting fees from other biopharmaceutical industry clients. Dr Kosiborod reported receiving personal fees from Alnylam, AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Cytokinetics, Dexcom, Eli Lilly, Janssen, Lexicon, Merck, Novo Nordisk, Pharmacosmos, Pfizer, scPharmaceuticals, Esperion Therapeutics, Structure Therapeutics, Vifor Pharma, Youngene Therapeutics, 35Pharma, and Applied Therapeutics to his institution; and grants from Boehringer Ingelheim and AstraZeneca to his institution outside the submitted work. Dr Vaduganathan reported receiving grants from Amgen, AstraZeneca, American Regent, Bayer, Boehringer Ingelheim, and Roche Diagnostics; receiving consulting fees from Amgen, AstraZeneca, American Regent, Baxter HealthCare, Bayer, Boehringer Ingelheim, Cytokinetics, Relypsa, Lexicon Pharmaceuticals, Tricog Health, Novo Nordisk, and Chiesi; serving on the advisory board for Amgen, AstraZeneca, American Regent, Baxter HealthCare, Bayer, Boehringer Ingelheim, Cytokinetics, Relypsa, Lexicon Pharmaceuticals, Tricog Health, Novo Nordisk, and Chiesi; receiving speaker fees AstraZeneca, Novartis, and Roche Diagnostics; and serving on a clinical trial committee for AstraZeneca, Novartis, Galmed, Occlutech, and Impulse Dynamics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence and Overlap of Cardiac, Renal, and Metabolic (CRM) Conditions in US Adults, 2015 Through March 2020
Percentage and weighted prevalence (in millions of persons) of noninstitutionalized US adults with CVD, CKD, and T2D overall (A), as well as single and overlapping CRM conditions (B). Error bars indicate 95% CIs. Unweighted Ns by CRM status: 486 participants with CVD only, 1000 with CKD only, 1099 with T2D only, 272 with CVD plus CKD, 213 with CVD plus T2D, 546 with CKD plus T2D, and 267 with CVD plus CKD plus T2D. CKD indicates chronic kidney disease; CVD, cardiovascular disease; and T2D, type 2 diabetes.
Figure 2.
Figure 2.. Distribution of Cardiovascular Disease (CVD) Type, Chronic Kidney Disease (CKD) Risk Stages, and Diagnosed vs Undiagnosed Type 2 Diabetes (T2D) in US Adults by Cardiac, Renal, and Metabolic (CRM) Status, 2015 Through March 2020
Proportion of individuals with atherosclerotic CVD (ASCVD) and heart failure (HF) among those with CVD (A), the distribution of selected Kidney Disease Improving Global Outcomes risk stages among individuals with CKD (B), and the proportion of previously diagnosed vs undiagnosed diabetes among all individuals with T2D (C), all by CRM status. Unweighted Ns by CRM status: 486 individuals with CVD only, 1000 with CKD only, 1099 with T2D only, 272 with CVD plus CKD, 213 with CVD plus T2D, 546 with CKD plus T2D, and 267 with CVD plus CKD plus T2D. aPoint estimates may be unreliable (relative SE ≥30%).
See this image and copyright information in PMC

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