Abstract Body (Do not enter title and authors here): Background: Progression along Cardiovascular-Kidney-Metabolic (CKM) stages confers greater cardiovascular disease (CVD) risk. However, the factors associated with CKM stage progression over time are not yet defined.

Methods: We evaluated ARIC Visit 4 (1996-98) participants without CVD at Visit 1 (1987-89) and with available data to define CKM stages at both Visits 1 and 4. CKM stages were defined as: stage 0, no CKM risk factors; stage 1, excess/dysfunctional adiposity; stage 2, metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, or diabetes) and/or moderate- to high-risk chronic kidney disease (CKD); stage 3, ≥20% predicted CVD risk per the PREVENT calculator or very high-risk CKD; and stage 4, clinical CVD. Among those in CKM stages 0-3 at Visit 1, we used logistic regression to concurrently assess the association of age, sex, race, area deprivation index (ADI, a measure of neighborhood deprivation), education, household income, physical activity (categorized as consistently ideal, intermediate, or consistently poor per AHA recommendations), and diet (per Life’s Essential 8 healthy diet score) with progression to a higher CKM stage from Visit 1 to Visit 4.

Results: Among 8,376 participants, the mean age at Visit 1 was 55 years, with 52% female and 21% Black adults. Older individuals had higher odds of CKM progression (OR: 1.49 [95% CI 1.42-1.56] per 5-years of age), whereas females had lower odds (OR: 0.72 [0.64-0.80]) and Black race did not have an independent association (Figure). More adverse social determinants of health were associated with higher odds of CKM progression, including higher ADI (deciles 7-10 vs deciles 1-3 OR: 1.39 [1.23-1.57]), lower income (<$12,000 vs ≥$50,000 OR: 1.40 [1.12-1.75]) and less education (grade school vs graduate school OR: 1.36 [1.10-1.67]). Higher physical activity levels were associated with lower odds of CKM progression (ideal vs poor OR: 0.82 [0.70-0.96]), while healthy diet score was not significantly associated with CKM stage progression.

Conclusion: Several sociodemographic and behavioral factors are associated with CKM stage progression. This understanding can help to guide population strategies to preserve and improve CKM health.