Abstract Body (Do not enter title and authors here): Background: Among Asian populations, there have been limited reports on the impact of cardiovascular-kidney-metabolic (CKM) syndrome stages on adverse cardiovascular outcomes. This study aims to explore the association between CKM stages and adverse cardiovascular outcomes in a Beijing community population
Methods: This study was a prospective cohort analysis conducted on a community-based Chinese population. The primary endpoint encompassed major adverse cardiovascular events (MACE), specifically cardiovascular death, acute myocardial infarction (AMI), or stroke. Conversely, secondary endpoint events encompassed cardiovascular death, AMI, stroke, or all-cause mortality. Cox regression models were employed to examine the associations between various stages of CKM and adverse cardiovascular outcomes.
Results: A total of 9,400 participants were enrolled in the study, with a median follow-up duration of 9.9 (9.8-10.0) years. During this period, there were 1,060 MACE, 179 cardiovascular deaths, 205 AMI, 841 strokes, and 541 all-cause deaths. The multivariate Cox model revealed that, compared with participants in the stage 0, those in the stage 2 exhibited a significantly elevated risk of MACE (HR=2.74; 95%CI: 1.49–5.06; P=0.001) and stroke (HR=2.78; 95%CI: 1.41–5.47; P=0.003). Participants in the stage 3 demonstrated a marked increase in the risk of MACE (HR=4.32; 95%CI: 2.32–8.05; P<0.001), AMI (HR=8.85; 95%CI: 1.19–65.84; P=0.033), and stroke (HR=4.15; 95%CI: 2.08–8.27; P<0.001). Furthermore, those in the stage 4 showed a substantial increase in the risk of MACE (HR=7.32; 95%CI: 3.93–13.63; P<0.001), cardiovascular death (HR=6.06; 95%CI: 1.41–26.07; P=0.016), AMI (HR=11.88; 95%CI: 1.59–88.75; P=0.016), stroke (HR=7.39; 95%CI: 3.71–14.70; P<0.001), and all-cause mortality (HR=2.13; 95%CI: 1.18–3.86; P=0.012). Subgroup analysis and interaction test discovered no significant interactions between stages of CKM and other risk factors, including age, sex, body mass index, homocysteine, glomerular filtration rate, smoking and drinking status(the P values for interactions were all greater than 0.05).
Conclusions: Our research indicates that advanced stages of CKM syndrome are linked to an increased risk of MACE, cardiovascular death, AMI, stroke and all-cause mortality. It is imperative to devise tailored management strategies for each phase of CKM syndrome in order to alleviate the healthcare burden.