Rest-activity rhythms and cardiovascular events in cardiovascular–kidney–metabolic syndrome: evidence from two nationwide cohorts

Jan 26, 2026American journal of preventive cardiology

Daily activity patterns linked to heart problems in people with combined heart, kidney, and metabolism conditions: findings from two large national studies

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Abstract

Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular events.

Higher RA was linked to a reduced risk of cardiovascular incidence, with hazard ratios of 0.87 for the second tertile and 0.79 for the third tertile.
Increased RA was associated with lower all-cause mortality risk, showing hazard ratios of 0.70 for the second tertile and 0.60 for the third tertile.
Higher RA also correlated with decreased cardiovascular mortality risk, with hazard ratios of 0.70 for the second tertile and 0.45 for the third tertile.
Higher intradaily variability (IV) was associated with an increased risk of all-cause mortality, with hazard ratios of 1.12 for the second tertile and 1.19 for the third tertile.
Inflammatory biomarkers were found to modestly mediate the associations between CRAR and health outcomes, accounting for 1%-5% of the effect.
The addition of CRAR data improved the prediction models for all-cause and cardiovascular mortality.

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BACKGROUND: Circadian rest-activity rhythm (CRAR) is a modifiable determinant of metabolic and cardiovascular health, yet its role in cardiovascular events and mortality among individuals with cardiovascular-kidney-metabolic (CKM) syndrome remains unclear.

METHODS: Accelerometer-derived CRAR parameters were analyzed in two nationally representative cohorts. Primary outcomes included cardiovascular incidence among participants with CKM stages 0-3 and all-cause and cardiovascular mortality among those with stages 1-4. Multinomial logistic and Cox proportional hazards models assessed associations of CRAR with CKM progression and subsequent outcomes. Mediation analyses examined inflammatory biomarkers, and improvements in prediction were evaluated using changes in C-statistics.

RESULTS: Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular incidence (T2: HR 0.87, 95% CI 0.82-0.93; T3: HR 0.79, 95% CI 0.73-0.85), all-cause mortality (T2: HR 0.70, 95% CI 0.64-0.77; T3: HR 0.60, 95% CI 0.54-0.67), and cardiovascular mortality (T2: HR 0.70, 95% CI 0.57-0.86; T3: HR 0.45, 95% CI 0.34-0.61). Higher intradaily variability (IV) was associated with increased all-cause mortality (T2: HR 1.12, 95% CI 1.02-1.22; T3: HR 1.19, 95% CI 1.08-1.30). Inflammatory biomarkers modestly mediated these associations (1%-5%). Optimal thresholds were RA = 0.87 for cardiovascular incidence, RA = 0.81 and IV = 0.68 for mortality. Adding CRAR to basic models improved prediction of all-cause and cardiovascular mortality (ΔC-statistic = 0.019 and 0.017). Results were validated in an independent cohort of 6046 participants.

CONCLUSION: Adverse CRAR is associated with CKM progression and elevated risks of cardiovascular events and mortality, highlighting its utility in identifying high-risk individuals and guiding targeted interventions through risk stratification and incremental prediction.

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Rest-activity rhythms and cardiovascular events in cardiovascular–kidney–metabolic syndrome: evidence from two nationwide cohorts

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