Treatment of Cardiometabolic Risk Factors Among U.S. Adults With Cardiovascular-Kidney-Metabolic Syndrome

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome highlights the inter-related nature of cardiometabolic risk factors, kidney disease, and cardiovascular disease (CVD) and represents an important target for intervention amid rising cardiovascular mortality in the United States. However, contemporary treatment patterns of major cardiometabolic risk factors in this high-risk population are not well defined. OBJECTIVES: The purpose of this study was to characterize national treatment rates of hypertension, diabetes, and hyperlipidemia among U.S. adults with CKM syndrome and to assess risk factor control among treated individuals from 2015 through 2023. METHODS: We analyzed data from adults aged ≥20 years with CKM stage 2 and above who participated in the National Health and Nutrition Examination Survey from 2015 through August 2023. Treatment rates for hypertension, diabetes, and hyperlipidemia and rates of blood pressure, glycemic, and cholesterol control among treated individuals were estimated using age- and sex-adjusted analyses that accounted for the complex survey design. RESULTS: The study included 6,384 adults with CKM stage 2 and above (weighted mean age 44.2 years; 51.2% women). Only approximately one-half of adults with hypertension (51.3% 95% CI: 49.7%-52.8%) or hyperlipidemia (48.8% 95% CI: 46.7%-51.0%) were receiving treatment, while diabetes treatment rates were higher (83.4% 95% CI: 80.1%-86.6%). Among treated individuals, blood pressure control was achieved in 44.7% (95% CI: 41.6%-47.7%), glycemic control in 47.3% (95% CI: 42.7%-51.8%), and cholesterol control in 68.2% (95% CI: 65.2%-71.1%). Treatment rates for hypertension and hyperlipidemia increased across higher risk strata, while blood pressure and glycemic control were lower among treated adults with higher 10-year CVD risk. Adults aged 20-44 years consistently had the lowest treatment rates across all 3 conditions (hypertension 27.6% 95% CI: 24.8%-30.3%, diabetes 73.7% 95% CI: 63.8%-83.7%, hyperlipidemia 19.7% 95% CI: 15.2%-24.3%), while women were less likely than men to receive treatment for diabetes and hyperlipidemia. Among racial and ethnic subgroups, Hispanic adults had the lowest treatment rates for hypertension and hyperlipidemia. CONCLUSIONS: Among U.S. adults with CKM syndrome, treatment of hypertension and hyperlipidemia was low, and fewer than one-half of treated individuals achieved blood pressure or glycemic control. Gaps in treatment initiation were most pronounced among young adults, women, and Hispanic adults, and inadequate risk factor control was particularly evident among those with higher cardiovascular risk. These findings highlight substantial opportunities to improve cardiometabolic care in this high-risk population.