Risk factor target achievement in relation to incident cardiovascular disease among individuals with cardiovascular-kidney-metabolic syndrome stage 1–3: results from a nationwide cohort study

The association between risk factor target achievement and the risk of incident cardiovascular disease (CVD) among individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 1–3 remains unclear. We investigated this association within the China Health and Retirement Longitudinal Study (CHARLS) cohort. This study included 6,501 individuals with CKM stages 1–3. The exposure of interest was the number of risk factor targets achieved at baseline, including systolic blood pressure (SBP) < 130 mm Hg, fasting blood glucose < 6.1 mmol/L, low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L, and moderate-to-vigorous physical activity. Cox proportional hazards regression models were used to analyse the association between the number of targets achieved and the risk of CVD. During a median follow-up of 9.0 years, 1,221 incident CVD events and 539 stroke events were documented. Compared with participants achieving no risk factor targets at baseline, those achieving all four targets had a significantly lower risk of both CVD (adjusted hazard ratio [aHR]: 0.40, 95% CI: 0.26–0.62) and stroke (aHR: 0.39, 95% CI: 0.20–0.75). Stratified analyses indicated that the inverse association between the number of achieved targets and CVD risk was stronger among participants younger than 60 years than among those aged 60 years or older ( P for interaction < 0.05). A greater number of risk factor targets achieved at baseline was associated with a lower subsequent risk of CVD in individuals with CKM stages 1–3.