Cumulative burden of cardiometabolic risk factors and risk of major adverse cardiovascular events and mortality: a community-based cohort study of 98,373 chinese adults

The rising prevalence of cardiometabolic risk factors in China poses a significant public health challenge. This study aimed to evaluate the prevalence and clustering of hypertension, diabetes, dyslipidemia, and overweight/obesity, and their associations with major adverse cardiovascular events (MACE) and all-cause mortality. We analyzed 98,373 adults (mean age 54.2 years; 60.7% female) without baseline cardiovascular disease (CVD) from the Guangdong sub-cohort of the China PEACE Million Persons Project (2016–2020). Participants were categorized by the number of cardiometabolic risk factors (0 to 4). Cox proportional hazards models were used to estimate hazard ratios (HRs) for MACE (a composite of myocardial infarction, coronary heart disease, heart failure, stroke, and cardiovascular death) and all-cause mortality. Only 23.5% of participants were free of all four risk factors, while 18.5% possessed three or more. Overweight/obesity (49.3%), hypertension (39.7%), and dyslipidemia (39.3%) were the most prevalent. Over a median follow-up of 5.02 years (IQR, 4.11–5.84; 481,162 person-years), compared to the 0-risk-factor group, the fully adjusted HRs for MACE were 1.37 (95% CI 1.29–1.47), 1.70 (1.60–1.81), 2.21 (2.07–2.36), and 2.92 (2.69–3.16) for participants with 1, 2, 3, and 4 risk factors, respectively (P-trend < 0.001). Similar dose–response relationships were found for all-cause mortality and individual CVD components, with the strongest association observed for heart failure (HR 4.01 for 4 factors). Cardiometabolic risk factors are highly prevalent and frequently clustered in southern Chinese adults. Greater cardiometabolic risk factor burden is significantly associated with future MACE and mortality, highlighting the need for integrated, multi-modal preventive strategies in community settings.