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. 2025 Sep;33(9):1791-1801.
doi: 10.1002/oby.24356. Epub 2025 Jul 29.

Cardiovascular Indexes and Oxidative Balance in Advanced Cardiovascular-Kidney-Metabolic Syndrome

Zhaoqi Yan  1 , Xiangyi Pu  1 , Xing Chang  1 , Ruxiu Liu  1
Affiliations

Cardiovascular Indexes and Oxidative Balance in Advanced Cardiovascular-Kidney-Metabolic Syndrome

Zhaoqi Yan et al. Obesity (Silver Spring). 2025 Sep.

Abstract

Objective: The cardiovascular-kidney-metabolic (CKM) syndrome lacks clear strategies for risk reduction.

Methods: This study utilized data from NHANES focusing on adults with CKM. Participants were categorized into early and advanced CKM. A multivariable logistic regression model evaluated the relationship between oxidative balance score (OBS) levels-total, dietary, and lifestyle-and advanced CKM. The mediating effects of cardiovascular indexes, atherogenic index of plasma (AIP), and cardiac metabolic index (CMI) were also analyzed. The SHapley Additive exPlanations (SHAP) in machine learning interpret the importance of indexes' components.

Results: Higher OBS levels were significantly associated with a lower risk of advanced CKM. Specifically, a total OBS ≥ 28 correlated with a 36% reduced risk compared to scores ≤ 16. AIP and CMI were linked to increased advanced CKM risk at levels > 0.56 and > 0.57, respectively. Mediation analysis showed AIP and CMI potentially mediated 0.68% and 4.08% of the OBS-advanced CKM risk association. SHAP highlighted the importance of carotene and niacin.

Conclusions: This study is the first to identify an inverse association between higher OBS and advanced CKM risk, with cardiovascular indexes emerging as potential mediators, which lay the groundwork for future longitudinal and interventional studies to elucidate potential causal pathways.

Keywords: atherogenic index of plasma; cardiac metabolic index; cardiovascular‐kidney‐metabolic syndrome; machine learning; national health and nutrition examination survey; oxidative balance score.

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