Associations of cardiovascular-kidney-metabolic conditions with all-cause and cardiovascular mortality among US adults: a population-based cohort study.

backgroundThe confluence of type 2 diabetes (T2D), cardiovascular disease (CVD), and chronic kidney disease (CKD)—collectively referred to as cardiovascular-kidney-metabolic (CKM) conditions—poses a significant public health challenge. This study assesses the impact of CKM conditions on all-cause and CVD mortality among US adults. METHODS AND

resultsUtilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, we conducted a prospective cohort analysis involving 42,697 participants. Subjects were stratified into eight categories based on the presence or absence of T2D, CVD, and CKD, either individually or in combination. The associations between these CKM conditions and mortality were evaluated using multivariable Cox proportional hazards models and Kaplan–Meier survival analysis, with mortality data obtained through the National Death Index up to December 31, 2019. The cohort, with a mean age of 47.11 years and comprising 51.1% women, demonstrated varied prevalence of CKM conditions: 6.6% with diabetes, 3.7% with CVD, and 8.0% with CKD. Over a median follow-up of 9.1 years, we observed 6,521 all-cause and 2,046 CVD-related deaths. The analysis revealed a graded increase in all-cause and CVD mortality risks associated with the number of CKM conditions, with the highest risk among individuals with all three conditions (Hazard Ratio [HR] for all-cause mortality: 3.50; 95% Confidence Interval [CI]: 2.86–4.28). Furthermore, younger adults (20–64 years) with all three CKM conditions faced a disproportionately higher mortality risk.

conclusionsCKM conditions are independently and cumulatively associated with elevated risks of all-cause and CVD mortality. This underscores the urgent need for comprehensive public health strategies and integrated care approaches to prevent and manage these conditions, thereby reducing mortality.