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. 2025 Feb 11;36(7):1343-1351.
doi: 10.1681/ASN.0000000637.

Cumulative Incidence of Mortality Associated with Cardiovascular-Kidney-Metabolic (CKM) Syndrome

Sophie E Claudel  1 , Insa M Schmidt  2 , Sushrut S Waikar  2 , Ashish Verma  2
Affiliations

Cumulative Incidence of Mortality Associated with Cardiovascular-Kidney-Metabolic (CKM) Syndrome

Sophie E Claudel et al. J Am Soc Nephrol. .

Abstract

Key Points:

  1. Cardiovascular–kidney–metabolic (CKM) syndrome stages 1–4 were associated with a graded risk of cardiovascular mortality in a nationally representative sample of US adults.

  2. Risk was similar between stages 0 and 1, suggesting that stage 1 represents a prime opportunity for prevention and risk mitigation.

  3. CKM staging is specific to cardiovascular mortality, given lack of a strong association with either noncardiovascular or cancer mortality.

Background: It is imperative to critically evaluate the prognostic implications of cardiovascular–kidney–metabolic (CKM) syndrome staging to inform clinical practice. The primary aims of this study were to define the risk of mortality associated with each CKM syndrome stage and to determine the corresponding restricted mean survival time over a 15-year period.

Methods: This was a longitudinal study of 50,678 community-dwelling US adults aged 20 years and older with baseline data for CKM stage determination participating in the 1999–2018 National Health and Nutrition Examination Survey. CKM stages were defined according to the American Heart Association presidential advisory. Fifteen-year adjusted cumulative incidences of cardiovascular mortality were calculated for each stage from confounder-adjusted survival curves using the G-formula.

Results: Over a median 9.5-year follow-up, 2564 participants experienced cardiovascular death. The 15-year adjusted cumulative incidences of cardiovascular mortality were stage 0, 5.5% (95% confidence interval [CI], 1.8 to 9.3); stage 1, 5.7% (95% CI, 3.2 to 8.2); stage 2, 7.9% (95% CI, 6.8 to 9.1); stage 3, 8.7% (95% CI, 6.7 to 10.8); and stage 4, 15.2% (95% CI, 13.6 to 16.8). The absolute risk difference between CKM stage 4 and stage 0 at 15 years was 9.6% (95% CI, 5.6 to 13.6). The survival difference between CKM stage 0 and stage 4 at 15 years was 8.1 (95% CI, 8.0 to 8.2) months.

Conclusions: Our findings reveal a graded risk of cardiovascular mortality associated with higher CKM syndrome stage.

Keywords: CKD; cardiovascular disease; diabetes mellitus; epidemiology and outcomes; mortality risk.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/F81.

References

    1. Ndumele CE Rangaswami J Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606–1635. doi: 10.1161/CIR.0000000000001184 - DOI - PubMed
    1. Ndumele CE Neeland IJ Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636–1664. doi: 10.1161/CIR.0000000000001186 - DOI - PubMed
    1. Powell-Wiley TM Poirier P Burke LE, et al. Obesity and cardiovascular disease A scientific statement from the American Heart Association. Circulation. 2021;143(21):E984–E1010. doi: 10.1161/CIR.0000000000000973 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention. Overweight & Obesity Statistics. Health Statistics; 2021. Accessed February 20, 2024. https://www.niddk.nih.gov/health-information/health-statistics/overweigh...
    1. Centers for Disease Control and Prevention National Center for Health Statistics. NHANES Questionnaires, Datasets, and Related Documentation. National Health and Nutrition Examination Survey; 2022. Accessed January 9, 2024. https://wwwn.cdc.gov/nchs/nhanes/default.aspx

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