Abstract Body (Do not enter title and authors here): Background: Cardiovascular disease (CVD) remains the leading cause of death in the U.S., with postmenopausal women aged 55 and older facing heightened risk. To enhance risk stratification, the American Heart Association recently introduced the Cardiovascular-Kidney-Metabolic (CKM) Syndrome, categorizing individuals into five progressive stages (0–4) based on metabolic and cardiovascular health.
Objective: This study aims to evaluate the distribution of CKM stages among postmenopausal women and examine their association with CVD mortality.
Methods: We conducted a retrospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999–2008, with CVD mortality follow-up through December 31, 2019. CKM stages were defined per AHA criteria: stage 0 (healthy), stage 1 (excess/dysfunctional adiposity), stage 2 (presence of conditions such as hypertension, metabolic syndrome, diabetes, or moderate-to-high chronic kidney disease), stage 3 (subclinical CVD or PREVENT score ≥20%), and stage 4 (clinical CVD). Cox regression models were used to estimate CVD mortality risk across CKM stages, using stages 0–1 as the reference, among postmenopausal women. Comparisons were also made by sex and race/ethnicity.
Results: The study included 2,195 postmenopausal women, representing approximately 14.3 million U.S. women, with a mean age of 66.7 years. The distribution of CKM stages 0 through 4 was 4.36%, 7.41%, 55.69%, 17.67%, and 14.87%, respectively. Over a median follow-up of 12.6 years, an estimated 2 million women died from CVD. While a greater proportion of men were classified as CKM stage 4 (23.4%), their relative CVD mortality risk (HR=4.10, 95% CI: 2.20–7.64) was slightly lower than that observed in women (HR=4.33, 95% CI: 1.94–9.68). Hispanic women at stage 4 had the highest risk across all sex and racial groups (HR=6.69).
Conclusion: Fewer than 5% of postmenopausal women were classified in the lowest-risk CKM stages, while over one-third were in the highest-risk categories (stages 3–4). CVD mortality risk at stage 4 was higher in women than in men, with Hispanic women facing the greatest risk. These findings highlight the need for targeted prevention and management strategies among postmenopausal women at advanced CKM stages.