Mortality Risks of Cardiovascular-Kidney-Metabolic Syndrome Components Based on a Large Asian Cohort of More than a Half Million Participants

[[abstract]]Background: The American Heart Association (AHA) has recently issued guidelines addressing the “Cardiovascular-Kidney-Metabolic (CKM) Syndrome” to mitigate cardiovascular diseases. This interdisciplinary concept of health medicine emphasizes the impact of multiple disease interactions rather than individual disease factors. This study aims to evaluate CKM prevalence and its associated components mortality risks in a substantial Asian cohort. Methods: The investigation focused on a cohort of 515,602 participants aged 20 years and above enrolled in a health screening program in Taiwan spanning from 1996 to 2017. The study assessed all-cause, cardiovascular disease (CVD) and cause-specific mortality related to CKM stages and its components—hypertension, diabetes, chronic kidney disease, metabolic syndrome, and hyperlipidemia. Multivariate Cox proportional hazards models were employed to calculate hazard ratios (HRs). We use Chiang's life table method to present the years of life lost for each CKM components. Results: Among this cohort, 67.2% had CKM, with prevalence rates of 25.3%, 34.6%, 4.8%, and 2.5% in Stages 1, 2, 3, and 4, respectively. Among those aged 60 and above, nearly 90% had CKM. CKM was associated with a higher risk of all-cause mortality (HR: 1.37, 95% CI: 1.31-1.43), and CVD mortality (HR: 2.12, 95% CI: 1.89-2.39). Each additional component of CKM was associated with a 23% increase in the risk of death (HR: 1.23, 95% CI: 1.22-1.24) and a 38% increase in the risk of CVD mortality (HR: 1.38, 95% CI: 1.36-1.40) compared to participants without any CKM components. With each additional component, the average life expectancy decreases by 3 years. Conclusion: The prevalence rates of CKM and its components vary, contributing to distinct risks of mortality. A clustering phenomenon exists among different components, where an increased number of components corresponds to a higher risk of all-cause, CVD mortality and end-stage kidney disease incidence.