Association Between Cardiovascular-Kidney-Metabolic Health and Early Arterial Injury in Young Adults in the United States: The Future of Families–Cardiovascular Health Among Young Adults Study

BACKGROUND: The American Heart Association recently introduced the novel construct of Cardiovascular-Kidney-Metabolic (CKM) Syndrome, but it is unclear how the CKM staging construct applies to young adults and how it may correlate with cardiovascular health status and carotid artery health. METHODS: In the FF-CHAYA study (Future of Families-Cardiovascular Health Among Young Adults), we defined CKM stages using the American Heart Association's framework. Cardiovascular health was measured by Life's Essential 8 scores (a composite metric consisting of dietary quality, physical activity, sleep, nicotine exposure, body mass index, blood glycemia, blood lipids, and blood pressure). We examined cross-sectional associations of CKM stages with Life's Essential 8 scores and carotid ultrasonography measures using multivariable regression models adjusted for age, self-identified gender, and self-identified race/ethnicity. RESULTS: Among 1283 FF-CHAYA participants (mean [SD] age, 22.9 [0.7] years; 54.4% women), 20.7% of participants were classified as Stage 0 CKM (no risk factors), 40.2% as Stage 1 CKM (excess adiposity), 36.2% as Stage 2 CKM (metabolic risk factors), and 2.8% as Stage 3 CKM (subclinical cardiovascular disease or advanced kidney disease). Compared with Stage 0, participants in Stages 1 to 3 had significantly lower Life's Essential 8 scores (β, -7.6 [95% CI, -9.4 to -5.8] for Stage 1, -13.9 [95% CI, -15.7 to -12.0] for Stage 2, -13.2 [95% CI, -17.4 to -9.0] for Stage 3). In addition, Stages 1 to 3 had significantly higher mean-mean and mean-maximum carotid intima-medial thickness and lower gray scale median compared with Stage 0. For example, mean-maximum carotid intima-medial thickness was 0.014 mm higher (95% CI, 0.005-0.020) for Stage 1, 0.020 mm higher (95% CI, 0.017-0.035) for Stage 2, and 0.100 mm higher (95% CI, 0.085-0.128) for Stage 3, compared with Stage 0. CONCLUSIONS: Among young adults, a more advanced CKM stage was associated with worse cardiovascular health, including greater evidence of early arterial injury. These findings elucidate the need for earlier preventive efforts and population-level interventions to address upstream drivers of CKM health.