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TOPLINE:
In a large, community-based cohort of older adults, most participants had poor cardiovascular-kidney-metabolic (CKM) health, with higher CKM stages linked to greater adverse cardiac remodeling progression and a more than eightfold higher risk for incident heart failure (HF).
METHODOLOGY:
- Researchers analyzed data from a cohort of older adults aged 66-90 years enrolled in the Atherosclerosis Risk in Communities (ARIC) study, spanning visit cycles 5 (2011-2013; n = 5646) and 7 (2018-2019; n = 2434), to assess the prevalence of CKM syndrome stages and their associations with changes in cardiac structure, cardiac functional decline, and the risk for incident HF.
- At both visits, participants who underwent echocardiography were categorized by CKM syndrome stage: stage 0 (no CKM risk factors), stage 1 (excess adiposity or prediabetes), stage 2 (metabolic risk factors or chronic kidney disease [CKD]), stage 3 (subclinical cardiovascular disease [CVD] with excess or dysfunctional adiposity, other metabolic risk factors, or CKD), and stage 4 (clinical CVD with excess or dysfunctional adiposity, other metabolic risk factors, or CKD).
- The outcomes were incident HF and a composite of incident HF and all-cause death.
TAKEAWAY:
- Overall, 96% of participants had CKM stage 2 or higher, reflecting poor CKM health across the cohort. At visit 5, only 2.2% had CKM stage 0 or 1, whereas 8.1% had CKM stage 2, 56% had CKM stage 3, and 32.6% had CKM stage 4.
- Over a median follow-up period of 9 years, 13.6% of participants assessed at visit 5 developed incident HF, with incidence rates increasing steeply across CKM stages. The risk for incident HF was 3.6-fold higher at CKM stage 3 and 8.3-fold higher at CKM stage 4, with CKM stage 2 as the reference (P for trend < .001).
- A similar stepwise pattern emerged for the composite outcome. Risk for the composite outcome was 1.1-fold higher at CKM stage 2, 2.1-fold higher at CKM stage 3, and 3.3-fold higher at CKM stage 4, using CKM stage 0 or 1 as the reference (P for trend < .001).
- Participants with higher CKM syndrome stages at visit 5 also experienced incrementally greater adverse cardiac remodeling by visit 7, including steeper declines in left ventricular systolic and diastolic function (P for trend < .001 for all).
IN PRACTICE:
“[Our] findings highlight the potential of the CKM syndrome framework to enhance HF risk stratification and potentially HF prevention efforts among older adults,” the authors wrote.
SOURCE:
The study was led by Mats C. Højbjerg Lassen, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online on April 1 in Circulation.
LIMITATIONS:
The researchers did not assess subclinical atherosclerotic CVD. They excluded 7.1% of participants with echocardiography data available at visit 5 due to missing staging variables and limited longitudinal echocardiographic analyses to survivors who returned for visit 7.
DISCLOSURES:
The ARIC study was funded by the National Heart, Lung, and Blood Institute; the National Institutes of Health; and the Department of Health and Human Services. Several authors reported receiving research grants, consulting fees, and/or lecture fees from, participating in clinical trial committees for, or serving on advisory boards for multiple pharmaceutical, healthcare, and research organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
