Progression in Cardiovascular-Kidney-Metabolic (CKM) Stages Over 7 Years in Mid-Life: The Dallas Heart Study
Abstract Body (Do not enter title and authors here): Introduction: While previous studies have quantified the community prevalence of Cardiovascular-Kidney-Metabolic (CKM) Stages, limited data exist regarding the expected progression of CKM Stages in mid-life.
Methods: Among participants in the population-sampled Dallas Heart Study (DHS) longitudinal cohort, we estimated the prevalence of CKM Stages at Visit 1 (DHS1; 2000-2002) and Visit 2 (DHS2, 2007–2009). Protocol measurements of body composition, lipids, fasting blood sugar, serum creatinine, NT-proBNP, hs-cTnT, urinary albumin and creatinine, coronary artery calcium by cardiac CT (CAC), and cardiac function and mass by cardiac MRI were conducted at both visits. To account for Visit 2 non-attendance, we performed additional sensitivity analysis using inverse probability of attrition weights (IPAW) with the following DHS1 variables as predictors of DHS2 attendance: age, sex, race, obesity, income, education level, eGFR, ejection fraction, cardiovascular risk score, and history of heart failure, coronary heart disease, or stroke.
Results: Among 2,991 participants at DHS1, 2030 also attended DHS2 and had an age of 44±10 years at DHS1 and 52±10 years at DHS2, 58% were female, and 50% reported non-Hispanic Black race/ethnicity. Over the median 6.8 (IQR 6.3-7.3) years between DHS1 and DHS2, the prevalence of CKM Stage 1 decreased from 14.7 to 10.8%; while the prevalence of CKM Stage 4 increased from 6% to 13%. Overall, 32% had progression in CKM Stage (Figure). Among the 280 (14%) participants who improved their CKM Stage, 206 (74%) derived from Stage 3 at DHS1, primarily meeting these criteria due to elevated troponin. Similar findings were observed in analyses incorporating IPAW to account for DHS2 non-attendance.
Conclusion: In a community-based cohort, CKM Stages progressed in nearly one-third over 7 years in mid-life. The prevalence of advanced CKM Stages (i.e., Stage 3 and 4) increased from 28% to 34%. The role and criteria of cardiac biomarkers in defining Stage 3 CKM warrant further study.
Shelbaya, Khaled
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Neeland, Ian
( University Hospitals - Case Western
, Cleveland
, Ohio
, United States
)
Ndumele, Chiadi
( JOHNS HOPKINS HOSPITAL
, Silver Spring
, Maryland
, United States
)
Shah, Amil
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Yang, Yimin
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Zeleke, Yinun
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Lamberson, Victoria
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Joshi, Parag
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Rohatgi, Anand
( UT SOUTHWESTERN
, Dallas
, Texas
, United States
)
Ayers, Colby
( UT Southwestern Medical Center
, Dallas
, Texas
, United States
)
Khera, Amit
( UT Southwestern
, Dallas
, Texas
, United States
)
De Lemos, James
( UT SOUTHWESTERN MEDICAL CTR
, Dallas
, Texas
, United States
)
Author Disclosures:
Khaled Shelbaya:DO have relevant financial relationships
;
Employee:Alexion Pharmaceuticals Inc:Active (exists now)
| Ian Neeland:DO have relevant financial relationships
;
Consultant:Boehringer Ingelheim:Past (completed)
; Advisor:MJH Life Sciences:Active (exists now)
; Advisor:Novo Nordisk:Past (completed)
; Speaker:Bayer:Active (exists now)
; Speaker:Eli Lilly:Active (exists now)
; Consultant:Eli Lilly:Past (completed)
; Speaker:Boehringer Ingelheim:Active (exists now)
| Chiadi Ndumele:DO NOT have relevant financial relationships
| Amil Shah:DO NOT have relevant financial relationships
| Yimin Yang:DO NOT have relevant financial relationships
| Yinun Zeleke:No Answer
| Victoria Lamberson:DO NOT have relevant financial relationships
| Parag Joshi:DO have relevant financial relationships
;
Research Funding (PI or named investigator):Novartis:Active (exists now)
; Consultant:New Amsterdam Pharma:Past (completed)
; Consultant:Kaneka:Past (completed)
; Consultant:Novartis:Past (completed)
; Research Funding (PI or named investigator):Kaneka:Past (completed)
; Research Funding (PI or named investigator):Eli Lilly:Active (exists now)
| Anand Rohatgi:DO have relevant financial relationships
;
Consultant:Raydel:Past (completed)
; Consultant:JP Morgan:Past (completed)
; Consultant:Johnson and Johnson:Past (completed)
; Other (please indicate in the box next to the company name):LabCorp:Active (exists now)
; Other (please indicate in the box next to the company name):Quest:Active (exists now)
; Research Funding (PI or named investigator):CSL Behring:Past (completed)
| Colby Ayers:DO have relevant financial relationships
;
Consultant:NIH:Active (exists now)
| Amit Khera:DO NOT have relevant financial relationships
| James de Lemos:DO have relevant financial relationships
;
Independent Contractor:Amgen, Inc.:Active (exists now)
; Independent Contractor:Verve:Active (exists now)
; Consultant:Siemen's:Past (completed)
; Independent Contractor:Jannsen:Active (exists now)
; Independent Contractor:Astra Zeneca:Past (completed)
; Independent Contractor:Merck:Active (exists now)
; Independent Contractor:Eli Lilli:Active (exists now)
; Independent Contractor:Varian:Active (exists now)
; Independent Contractor:Regerenon Pharmaceuticals:Active (exists now)
