Associations of Cardiovascular-Kidney-Metabolic Syndrome (CKM) Stages with All-Cause Mortality and Longitudinal Transitions of CKM Stages in a Population-Based Cohort.

Cardiovascular-kidney-metabolic (CKM) syndrome is a major global public health challenge. In Northwestern China, which has unique socio-economic and demographic characteristics and arid climate, its prevalence, stage transition dynamics, and mortality associations remain unexplored.We included 9,116,728 adults aged ≥18 years who underwent annual health check-ups between 2019 and 2023 in Northwestern China. Cardiovascular-kidney-metabolic (CKM) stages were defined according to the American Heart Association criteria. Mortality information was obtained from local death registrations. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs) of mortality risk associated with CKM stages. The probabilities of CKM stage transition and progression to death were estimated using a multistate Markov model.During a median follow-up of 3.78 years, the average prevalence of stages 1-4 CKM was 88.1%. Stage 2 CKM syndrome was the most prevalent (53.9%), and stage 4 showed a significant upward trend (annual percentage change, 23.03%; 95% confidence interval [CI] 22.63-23.43). Patients with stages 2-4 CKM were at increased risk of all-cause mortality, with HRs (95% CIs) of 1.15 (1.13-1.17), 1.43 (1.40-1.46), and 2.93 (2.88-2.99) for stages 2, 3, and 4, respectively, compared with stage 0. Stage 4 had the highest 5-, 10-, and 20-year cumulative death probabilities (12.3%, 16.0%, and 24.2%, respectively), whereas 68.7%-80.6% of individuals with non-advanced stages of CKM remained in or transitioned between stages 1-3 over 20 years.Adults in Northwestern China are facing a substantial CKM burden. CKM stage 4 has emerged as a critical risk end point, with its prevalence and associated mortality accelerating, while stages 0-3 CKM are highly reversible. Findings from this study highlight the need for early screening, dynamic monitoring of CKM stages, and optimisation of interventions focussing on preventing progression to stage 4.

Duke Scholars

Author Chenxinan Ma