Racial/ethnic disparities in stages of cardiovascular-kidney-metabolic syndrome among reproductive-aged women in the United States: NHANES 2011-2020.

Objective: Recently, the American Heart Association defined, staged, and highlighted the multisystem consequences of poor cardiovascular-kidney-metabolic (CKM) syndrome health with a clarion call to harmonize guidelines and provide opportunities for actionable preventive interventions before overt CVD. In the United States, the components that comprise CKM (obesity, diabetes, hypertension, etc.) are potent risk factors for poor maternal and neonatal outcomes, with a disproportionate burden among racial/ethnic minorities. However, population-level data on CKM syndrome in reproductive-aged women are scarce, but a critical prerequisite in evaluating the impact of CKM stages on overall pregnancy outcomes. Methods: We analyzed 2347 non-pregnant, reproductive-aged women (≥20-49 years) from the National Health and Nutrition Examination Survey (NHANES) who had data on all CKM risk factors. We incorporated sampling weights into our analysis to account for the complex NHANES survey design. CKM stages were defined as follows: Stage 0: optimal CKM health with no risk factors; Stage 1: excess/dysfunctional adiposity or early metabolic abnormalities; Stage 2: established metabolic risk factors and/or CKD; Stage 3: high predicted 10-year CVD risk and/or subclinical CVD or high-risk CKD; Stage 4: established clinical CVD. We reported prevalence estimates and standard errors of CKM syndrome stages in the overall population by race/ethnicity and across the study period (2011-2020). Results: The mean age was 34.6 ± 7.7 years, with 57.3% non-Hispanic (NH) White, 18.8% Hispanic, 13.2% NH Black, 6.4% NH Asian, and 4.3% self-reported other races. Over the study period, 74.7% of participants had CKM syndrome (Stage 1: 37.3%, Stage 2: 35.7%, Stage 3: 0.3%, and Stage 4: 1.97%) with notable variations. NH Black women had the lowest prevalence of Stage 0 CKM (13.2%) and the highest prevalence of Stages 2 (42.3%) and 3 (1.1%) CKM. Hispanic and other minority women had the highest prevalence of Stages 1 (43.42%) and 4 (5.11%) CKM, respectively ( Conclusion: The high prevalence of CKM syndrome in reproductive-aged women in the United States, with notable racial/ethnic disparities, underscores a clarion call to intensify health equity efforts aimed at mitigating CKM risk in women of childbearing age. Studies evaluating the implications of these findings for overall pregnancy outcomes are urgently warranted.