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September 10, 2025Open Access

Association between cardiovascular–kidney–metabolic health metrics and long-term cardiovascular risk: Findings from the Chinese Multi-provincial Cohort Study

Key Points

Higher CKM stage is related to increased cardiovascular disease risk, with significant rates among participants aged less than 60 years.
Among 5293 participants, 91.2% exhibited at least one abnormal CKM health metric, leading to 710 incident cardiovascular disease cases during follow-up.
Participants with CKM stage 2 had a hazard ratio of 2.27 for cardiovascular incidence, indicating a severe increase in risk.
The findings suggest that poor CKM health metrics should be recognized and managed to prevent cardiovascular disease effectively.

Abstract

Abstract Background: The American Heart Association (AHA) introduced the concept of cardiovascular–kidney–metabolic (CKM) health and stage, reflecting the interaction among metabolism, chronic kidney disease (CKD), and the cardiovascular system. However, the association between CKM stage and the long-term risk of cardiovascular disease (CVD) has not been validated. This study aimed to evaluate the long-term CVD risk associated with CKM health metrics and CKM stage using data from a population-based cohort study. Methods: In total, 5293 CVD-free participants were followed up to around 13 years in the Chinese Multi-provincial Cohort Study. Considering the pathophysiologic progression of CKM health metrics abnormalities (comprising obesity, central adiposity, prediabetes, diabetes, hypertriglyceridemia, CKD, and metabolic syndrome), participants were divided into CKM stages 0, 1, and 2. The time-dependent Cox regression models were used to estimate the cardiovascular risk associated with CKM health metrics and stage. Additionally, broader CVD outcomes were examined, with a specific assessment of the impact of stage 3 in 2581 participants from the CMCS-Beijing subcohort. Results: Among participants, 91.2% (4825/5293) had at least one abnormal CKM health metric, 8.8% (468/5293), 13.3% (704/5293), and 77.9% (4121/5293) were in CKM stages 0, 1, and 2, respectively; and 710 incident CVD cases occurred during a median follow-up time of 13.3 years (interquartile range: 12.1 to 13.6 years). Participants with each poor CKM health metric exhibited significantly higher CVD risk. Compared with stage 0, the hazard ratio (HR) (95% confidence interval CI) for CVD incidence was 1.31 (0.84–2.04) in stage 1 and 2.27 (1.57–3.28) in stage 2. Significant interactive impacts existed between CKM stage and age or sex, with higher CVD risk related to increased CKM stages in participants aged <60 years or females. Conclusion: These findings highlight the contribution of CKM health metrics and CKM stage to the long-term risk of CVD, suggesting the importance of multi-component recognition and management of poor CKM health in CVD prevention.

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