What question did this study set out to answer?

The aim is to characterize the prevalence and mortality risks associated with cardiovascular-kidney-metabolic syndrome stages in US adults over nearly two decades.

March 10, 2026Open Access

Prevalence and mortality of cardiovascular-kidney-metabolic syndrome in US adults, 1999–2018

Puntos clave

The aim is to characterize the prevalence and mortality risks associated with cardiovascular-kidney-metabolic syndrome stages in US adults over nearly two decades.
Utilized data from the National Health and Nutrition Examination Survey (1999-2018).
Defined CKM stages from 0 (no risk factors) to 4 (clinical CVD).
Excluded participants under 20 years, pregnant individuals, and those with missing data.
Calculated age- and sex-adjusted prevalence and trends for each CKM stage.
Employed survey-weighted Cox regression to assess mortality risk associated with CKM stages.
CKM syndrome prevalence was 11.9% (stage 0), 24.9% (stage 1), 49.1% (stage 2), 4.6% (stage 3), and 9.5% (stage 4).
Prevalence of stages 0 and 4 decreased, while stages 1 and 3 increased between 1999 and 2018.
All-cause mortality risk increased with CKM stage: HR for stage 4 was 2.87 compared to stage 0.
CVD mortality risk also increased, with HR for stage 4 reported as 4.68 compared to stage 0.
Metabolic abnormalities contributed significantly to the mortality gradient.

Resumen

Cardiovascular-kidney-metabolic (CKM) syndrome is a novel staging construct that reflects the pathophysiological interplay between these individual conditions. The long-term trends in the prevalence of CKM syndrome in the US have not been well characterized. This serial cross-sectional study used data from the National Health and Nutrition Examination Survey (1999–2018) to define CKM stages from 0 (no risk factors) to 4 (clinical CVD). Participants younger than 20 years, pregnant patients, and those with missing mortality data and NHANES fasting subsample weights were excluded. We calculated the age- and sex-adjusted prevalence of each stage and its trends. Survey-weighted Cox regression was used to estimate the mortality risk with each stage. The prevalence of CKM syndrome at each stage was as follows: stage 0, 11.9%; stage 1, 24.9%; stage 2, 49.1%; stage 3, 4.6%; and stage 4, 9.5%. The prevalence of CKM stages 0 and 4 decreased between 1999 and 2018, but that of CKM stages 1 and 3 increased. The risk of all-cause and CVD mortality showed a graded increase from stage 1 to 4 compared to stage 0 (HRs for all-cause death in stage 4 = 2.87, 95% CI: 1.98–4.17, and CVD death = 4.68, 95% CI: 1.95–11.26). Nearly 90% of US adults have Stage 1 or higher CKM syndrome, and CKM stage is associated with graded mortality risk. Metabolic abnormalities explain the largest share of the mortality gradient, suggesting that population and clinical strategies focused on metabolic risk reduction should be prioritized to reduce CKM-related mortality. • We examined the prevalence and mortality of cardiovascular-kidney-metabolic (CKM) syndrome stages in US adults between 1999 and 2018. • Almost 90% of US adults had stage 1 or higher CKM syndrome. • The prevalence of CKM stages 0 and 4 decreased between 1999 -2018, but that of CKM stages 1 and 3 increased. • The risk of all-cause and CVD mortality showed a graded increase from stage 1 to 4 compared to stage 0. • Metabolic factors drive most of the excess mortality, highlighting the importance of targeting metabolic risk in prevention and care.

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