Associations of Cardiovascular–Kidney–Metabolic Syndrome With All‐Cause and Cardiovascular Death and the Progression of Cardiovascular–Kidney–Metabolic Syndrome Among Hong Kong Chinese People Over 2 Decades

Background In 2023, the American Heart Association established the cardiovascular–kidney–metabolic (CKM) syndrome and defined its different stages. Here, we analyzed the prospective associations of CKM stages with mortality outcomes and how CKM syndrome progresses over time. Methods This observational study used data from the Hong Kong CRISPS (Cardiovascular Risk Factor Prevalence Study) 2, a population‐based cohort involving community‐dwelling Chinese participants who underwent comprehensive health assessment between 2000 and 2004 and were followed for 20 years. Cox proportional hazards regression models were performed to evaluate the associations between CKM stages and mortality outcomes. Results A total of 1912 eligible participants were included in the analyses (mean age, 52.5±12.0 years; 46.3% men). At baseline, 240 (12.6%), 240 (12.6%), 1243 (65.0%), 149 (7.8%), 40 (2.1%) had CKM stages 0, 1, 2, 3, and 4, respectively. At 20 years, the adjusted hazard ratios of CKM stages 3 and 4 for all‐cause mortality were 3.8 (95% CI, 1.8–7.9; P <0.001) and 3.7 (95% CI, 1.6–8.3; P =0.002) and for cardiovascular mortality were 17.4 (95% CI, 2.3–133.0; P =0.006) and 21.4 (95% CI, 2.5–187.3; P =0.006), respectively. Among early CKM stages 0 to 2, compared with no CKM at baseline, CKM stage 2 was significantly associated with a higher risk of progression to advanced CKM stages 3 and 4 (odds ratio, 3.9 [95% CI, 2.3–6.7]; P <0.001). Conclusions Advanced CKM syndrome is associated with long‐term mortality outcomes including all‐cause and cardiovascular death, underscoring the importance of early screening and staging of CKM syndrome to prevent disease progression and reduce mortality risk.