Over a median follow-up of 109 months, 5,583 all-cause deaths and 1,843 cardiovascular disease (CVD)-specific deaths occurred.
Advanced stages of cardiovascular-kidney-metabolic () syndrome are linked to higher all-cause and CVD mortality risks.
Elevated (SIRI) is correlated with increased mortality from all causes and CVD.
Individuals with advanced CKM stages (Stages 3-4) and elevated SIRI (> 0.81) face the highest mortality risks, with hazard ratios of 1.84 for all-cause and 2.50 for CVD mortality.
The associations between CKM stages, SIRI, and mortality are particularly significant in adults under 60 years.
Findings suggest the need for targeted interventions that address both CKM progression and systemic inflammation.
Simplified
BACKGROUND: Cardiovascular-kidney-metabolic () syndrome and systemic inflammation significantly contribute to mortality. However, the joint associations of CKM stages and systemic inflammation with all-cause and cardiovascular disease (CVD) mortality remain unclear. This study aimed to evaluate the independent and joint associations of CKM stages and systemic inflammation with all-cause and CVD mortality in a representative cohort of United States adults.
METHODS: We analyzed data from 29,459 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (1999-2018). CKM stages were classified based on metabolic risk factors, CVD, and chronic kidney disease. Systemic inflammation was assessed using multiple indicators, and time-dependent ROC analysis identified the (SIRI) as the most effective inflammatory marker. The associations of CKM stages and SIRI with mortality were evaluated.
RESULTS: Over a median follow-up of 109 months, 5,583 all-cause deaths and 1,843 CVD-specific deaths occurred. Both advanced CKM stages and elevated SIRI were associated with higher risks of all-cause and CVD mortality. Individuals with advanced CKM stages (Stages 3-4) and elevated SIRI (> 0.81) had the highest risks of all-cause (HR: 1.84, 95% CI: 1.65-2.05) and CVD mortality (HR: 2.50, 95% CI: 2.00-3.12). These associations were particularly pronounced in adults aged < 60 years (P for interaction < 0.001).
CONCLUSIONS: Advanced CKM stages and elevated SIRI are associated with increased risks of all-cause and CVD mortality, particularly in younger adults. These findings highlight the significance of targeted interventions to address systemic inflammation and CKM progression, potentially improving long-term outcomes in high-risk populations.
Key numbers
1.84×
Increase in All-Cause Mortality Risk
Risk of all-cause mortality for Stages 3-4 with > 0.81
2.50×
Increase in CVD Mortality Risk
Risk of CVD mortality for Stages 3-4 with > 0.81
41.14%
All-Cause Mortality Rate at Stage 4
Percentage of all-cause mortality in participants at Stage 4
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Declarations. Ethics approval and consent to participate: Ethics approval and consent to participate The National Center for Health Statistics and Ethics Review Board approved the protocol for NHANES, and all participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
