Incidence of cardiovascular-kidney-metabolic syndrome and its risk factors for progression in China

BackgroundCardiovascular-kidney-metabolic syndrome (CKM syndrome) has become one of the leading causes of death. However, its prevalence and factors associated with its progression are unknown. In this study, we investigate the incidence of CKM syndrome in middle-aged and elderly individuals, identify the risk factors for CKM syndrome progression via 4 years of follow-up data, explore CKM syndrome prevalence and identify prevention strategies. MethodsThis was a retrospective cohort study using China Health and Retirement Longitudinal Study (CHARLS) data with a four-year follow-up period (2011--2015), which is a multilevel complex sampling design survey of the Chinese population used to represent the national population. We retrospectively included 4821 participants (27.2% of all participants, mean age = 58 years, 54.1% were female) with sufficient CKM indicator data from CHARLS. We investigated the incidence and progression of CKM syndrome in Chinese adults by building a multivariate logistic regression model to analyze the additional risk factors for CKM progression, focusing on the potential social determinants of health (SDOHs). ResultsIn the baseline survey, after weighting, the proportions of patients with stages 0-4 CKM syndrome were 10.5%, 17.0%, 46.3%, 12.1%, and 14.1%, respectively. During the 4-year follow-up, 27.20% of patients experienced CKM deteriorated. A higher CRP (OR =1.55, 95% CI: 1.06-2.28, P = 0.02), Chinese visceral obesity index (CVAI) (OR = 1.81, 95% CI: 1.31-2.52, P < 0.001), and conicity index (CI) (OR = 1.34, 95% CI: 1.01-1.79, P = 0.04) were identified as risk factors for CKM deterioration. ConclusionCKM syndrome incidence is extremely high in middle-aged and elderly people in China, with rapid and severe progression. Additional risk factors and predictive indications related to the staged progression of CKM syndrome should be actively explored to achieve the slowing and reversal of CKM syndrome deterioration. Key PointsThis cohort study investigated the prevalence of CKM syndrome and explored the factors related to its progression and recovery. QuestionWhat is the prevalence of CKM syndrome, and what factors affect its progression? FindingsIn this cohort study of 4821 participants with 4 years of follow-up, a high incidence of CKM syndrome and a high risk of CKM deterioration were observed in the Chinese middle-aged and elderly population. MeaningThe findings of this study support the recommendations of the AHA that additional risk factors and predictive indicators for the progression of CKM should be actively explored.