Associations of Cumulative Burden of Prehypertension, Prediabetes and Predyslipidemia With All‐Cause and Cardiovascular Disease Mortality: A Retrospective Cohort Study

We aimed to examine the individual and combined impact of prehypertension, prediabetes, and predyslipidemia on all-cause and cardiovascular disease (CVD) mortality in community-dwelling adults. A retrospective cohort study of 11 986 US adults from the 1999-2018 National Health and Nutrition Examination Survey was conducted. Participants were categorized into four mutually exclusive groups based on the cumulative number of these conditions. Multivariate Cox proportional hazards models were applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes. The prevalences of no, one, two, and all three preclinical conditions were 37.20%, 38.39%, 19.86%, and 4.55%, respectively. Over a median follow-up of 10 years, 636 (3.83%) deaths occurred, including 170 (26.73%) from CVD. In a dose-response manner, the adjusted HRs (95%CIs) for all-cause mortality among those with one, two, and three conditions were 1.87 (1.38-2.52), 2.49 (1.80-3.44), and 2.62 (1.76-3.90), respectively, compared to those with none. The corresponding HRs (95%CIs) for CVD mortality were 3.09 (1.66-5.78), 3.89 (2.06-7.36), and 4.20 (2.04-8.69), respectively. Thus, an increasing cumulative number of preclinical conditions is associated with graded elevated risk of all-cause and CVD mortality, underscoring the potential for early intervention during the preclinical phase to improve long-term health outcomes.