Cardiovascular–Kidney–Metabolic Syndrome Stages and Heart Failure Risk in ARIC Study

Circulation, Ahead of Print. BACKGROUND:Suboptimal cardiovascular–kidney–metabolic (CKM) health is highly prevalent in the United States, especially among older adults, but whether the CKM syndrome staging framework is predictive of incident heart failure (HF) in this population remains uncertain.METHODS:Participants from the ARIC Study (Atherosclerosis Risk in Communities; visit 5, 2011–2013) who underwent echocardiography were categorized according to the American Heart Association CKM syndrome staging framework, which is based on excess or dysfunctional adiposity, metabolic risk factors, kidney disease, subclinical cardiovascular disease (CVD), and clinical CVD.

We evaluated the association between CKM stage and prevalence and progression of cardiac remodeling and longitudinal risk of incident HF.RESULTS:Of the 5646 participants who had data available for CKM staging (age range, 66 to 90 years; 3271 women [57.9%]), 24 (0.4%) were stage 0 (optimal CKM health), 104 (1.8%) stage 1, 460 (8.1%) stage 2, 3197 (56.0%) stage 3, 1842 (32.3%) stage 4a, and 19 (0.3%) stage 4b. Higher CKM stage was incrementally associated with adverse left ventricular remodeling, worse left ventricular systolic and diastolic function, and greater progression of adverse remodeling by visit 7 (2018–2019).