Joint Relationship of Cardiovascular-kidney-metabolic Syndrome and Psoriasis with All-cause and Cause-specific Mortality in Adults: A Population-based Analysis

Psoriasis has been associated with cardiovascular risk, but the combined association of psoriasis and cardiovascular-kidney-metabolic (CKM) syndrome with mortality remains unclear. This study examined the individual and joint associations of CKM syndrome and self-reported psoriasis with allcause and cardio-cerebrovascular disease (CCD) mortality among 9,598 U.S. adults aged ≥20 years from NHANES 2003-2006 and 2009-2014. CKM syndrome stages were defined according to the 2023 American Heart Association framework, and psoriasis was assessed by self-reported physician diagnosis. Mortality was ascertained through linkage to the National Death Index through 2019. During a median follow-up of 9.3 years, 860 deaths occurred. Advanced CKM syndrome was associated with higher all-cause mortality (HR=3.67; 95% CI: 3.00-4.50) and CCD mortality (HR=8.16; 95% CI: 5.42-12.28). Psoriasis was also associated with higher all-cause mortality (HR=2.06; 95% CI: 1.47-2.90) and CCD mortality (HR=2.69; 95% CI: 1.42-5.08). Participants with both advanced CKM syndrome and psoriasis had the highest observed risks of all-cause mortality (HR=7.09; 95% CI: 4.93-10.19) and CCD mortality (HR=16.47; 95% CI: 7.26-37.33). Formal interaction testing did not show significant multi-plicative interaction for all-cause mortality (p for interaction=0.16) or CCD mortality (p for interaction=0.80). These findings suggest that coexisting advanced CKM syndrome and psoriasis may identify adults with particularly elevated mortality risk.