Abstract 4368885: Progression in Cardiovascular-Kidney-Metabolic (CKM) Stages Over 7 Years in Mid-Life: The Dallas Heart Study

Introduction: While previous studies have quantified the community prevalence of Cardiovascular-Kidney-Metabolic (CKM) Stages, limited data exist regarding the expected progression of CKM Stages in mid-life. Methods: Among participants in the population-sampled Dallas Heart Study (DHS) longitudinal cohort, we estimated the prevalence of CKM Stages at Visit 1 (DHS1; 2000-2002) and Visit 2 (DHS2, 2007–2009). Protocol measurements of body composition, lipids, fasting blood sugar, serum creatinine, NT-proBNP, hs-cTnT, urinary albumin and creatinine, coronary artery calcium by cardiac CT (CAC), and cardiac function and mass by cardiac MRI were conducted at both visits. To account for Visit 2 non-attendance, we performed additional sensitivity analysis using inverse probability of attrition weights (IPAW) with the following DHS1 variables as predictors of DHS2 attendance: age, sex, race, obesity, income, education level, eGFR, ejection fraction, cardiovascular risk score, and history of heart failure, coronary heart disease, or stroke. Results: Among 2,991 participants at DHS1, 2030 also attended DHS2 and had an age of 44±10 years at DHS1 and 52±10 years at DHS2, 58% were female, and 50% reported non-Hispanic Black race/ethnicity. Over the median 6.8 (IQR 6.3-7.3) years between DHS1 and DHS2, the prevalence of CKM Stage 1 decreased from 14.7 to 10.8%; while the prevalence of CKM Stage 4 increased from 6% to 13%. Overall, 32% had progression in CKM Stage ( Figure) . Among the 280 (14%) participants who improved their CKM Stage, 206 (74%) derived from Stage 3 at DHS1, primarily meeting these criteria due to elevated troponin. Similar findings were observed in analyses incorporating IPAW to account for DHS2 non-attendance. Conclusion: In a community-based cohort, CKM Stages progressed in nearly one-third over 7 years in mid-life. The prevalence of advanced CKM Stages (i.e., Stage 3 and 4) increased from 28% to 34%. The role and criteria of cardiac biomarkers in defining Stage 3 CKM warrant further study.