Progression of Cardiovascular-Kidney-Metabolic Syndrome among Hispanics/Latinos in the United States

BACKGROUND: Cardiovascular-kidney-metabolic syndrome (CKM) describes the clustering of risk factors and progression of disease at the intersection of metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD). We aimed to characterize the prevalence of CKM stages and progression of CKM syndrome among diverse U.S. Hispanic/Latino adults. METHODS: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a population-based longitudinal cohort of 16,415 Hispanic/Latino adults aged 18-74 years from four U.S. communities. Participants completed examinations at visit 1 (V1, 2008-2011) and visit 2 (V2, 2014-2017). Data collected included body mass index, waist circumference, glucose tolerance, lipids, blood pressure, metabolic syndrome, CKD, 10-year CVD risk (to define subclinical CVD), and clinical CVD. CKM stages were defined using American Heart Association criteria: stage 0 (no CKM risk factors), stage 1 (excess/dysfunctional adiposity), stage 2 (metabolic risk factors or CKD), stage 3 (subclinical CVD or risk equivalents), and stage 4 (clinical CVD). We estimated the age-standardized prevalence of CKM stages at V1 (n=16,123) and CKM stage progression from V1 to V2 (n=11,178). All analyses were weighted and accounted for the HCHS/SOL complex survey design. RESULTS: At V1, the mean age was 41.1 years, and 52.3% were female. The distribution of CKM stages was: stage 0, 10.6% (standard error (SE): 0.4); stage 1, 26.1% (SE: 0.6); stage 2, 50.6% (SE: 0.6); stage 3, 2.4% (SE: 0.2); and stage 4, 10.3% (SE: 0.3). Over an average follow-up of six years, 10.3% (SE: 0.5) regressed to a lower CKM stage, while 21.5% (SE: 0.7) progressed to a higher CKM stage. CONCLUSIONS: Among diverse U.S. Hispanic/Latino adults, eight in ten had CKM risk factors or subclinical CVD, and one in five experienced CKM progression over six years. These findings highlight the need for targeted, early-stage interventions to prevent CKM progression and improve CKM health in Hispanic/Latino populations.