Safety and Efficacy of Intensive BP Control in Cardiovascular-Kidney-Metabolic Syndrome

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular-kidney-metabolic (CKM) syndrome stages 1-3 (n=6501). Intervention: Achievement of four baseline risk factor targets (SBP < 130 mm Hg, FBG < 6.1 mmol/L, LDL-C < 2.6 mmol/L, and moderate-to-vigorous physical activity) vs. Achievement of zero risk factor targets. Primary outcome: Incident cardiovascular disease (CVD) (aHR 0.40, 95% CI 0.26-0.62).

Yuzhe Yin; Xiaopu Wang; Keyang Zheng; Tienan Sun; Biyang Zhang; Rite Si; Jingyi Xiao; Yunwen Wang; Zixu Zhao; Xinqun Hu; Zhe Li; Junyu Pei; Peng Hao; Yongjian Wu

doi:10.1016/j.jacc.2025.07.057

October 1, 2025Journal of the American College of Cardiology

Safety and Efficacy of Intensive BP Control in Cardiovascular-Kidney-Metabolic Syndrome

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Why the study?

Does the joint achievement of guideline-recommended risk factor targets prevent incident cardiovascular disease in individuals with cardiovascular-kidney-metabolic (CKM) syndrome?

Study Design

Type

Cohort (n=6,501)

Multicenter

Yes

Structured PICO

Does the joint achievement of guideline-recommended risk factor targets prevent incident cardiovascular disease in individuals with cardiovascular-kidney-metabolic (CKM) syndrome?

P

Population

6,501 community-dwelling Chinese adults aged 45 and older with cardiovascular-kidney-metabolic syndrome stages 1-3 and no prior cardiovascular disease, followed for a median of 9.0 years.

E

Exposure

Achievement of guideline-recommended risk factor targets at baseline (1 to 4 targets: SBP <130 mm Hg, FBG <6.1 mmol/L, LDL-C <2.6 mmol/L, and engagement in moderate-to-vigorous physical activity).

C

Comparator

Achievement of zero baseline risk factor targets.

O

Outcome

Incident cardiovascular disease (CVD), defined as a new self-reported, physician-diagnosed history of heart disease (including angina, myocardial infarction, congestive heart failure, or other heart conditions) and stroke.composite

Main Result

Hazard Ratio: 0.4 (95% CI 0.26–0.62)

Absolute Event Rate: 10.7% vs 25.7%

In patients with cardiovascular-kidney-metabolic (CKM) syndrome, achieving multiple guideline-directed risk factor targets is associated with a substantially reduced risk of incident cardiovascular disease, particularly in younger individuals.

Limitations

Risk factor target achievement was determined from a single baseline assessment, limiting insight into sustained risk factor management.
Exposure variables and CKM staging criteria shared common baseline data sources, limiting causal interpretation.
Data-driven constraints for CKM staging, including relying on eGFR alone for CKD risk stratification.
Proxy definitions for CKM Stage 3 may misclassify some participants.
Exact date of cardiovascular events is unknown due to ascertainment at discrete survey waves.
Residual confounding from unmeasured variables.
Outcome ascertainment relied on self-reported physician diagnoses, subject to recall bias.
Findings from an exclusively Chinese population may not generalize to other ethnic groups.
Risk factor target achievement was determined from a single baseline assessment rather than reflecting sustained risk factor management over time.
Exposure variables and CKM staging criteria shared common baseline data sources (e.g., SBP and FBG components are related to hypertension and diabetes used for staging), limiting causal interpretation.
CKM staging was subject to data constraints, relying on eGFR alone for Stage 2 CKD risk and using PREVENT equations to define Stage 3 instead of direct echocardiographic/NT-proBNP data.

Implication

Supports comprehensive risk-factor control in CKM syndrome despite only 3.6% achieving all targets; leaves open whether intensive multifactorial intervention causally reduces events.

Abstract

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Discussion

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Cite This Study

Yin et al. (2025) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stages 1-3 (n=6,501). Achievement of four baseline risk factor targets (SBP < 130 mm Hg, FBG < 6.1 mmol/L, LDL-C < 2.6 mmol/L, and moderate-to-vigorous physical activity) vs. Achievement of zero risk factor targets was evaluated on Incident cardiovascular disease (CVD) (aHR 0.40, 95% CI 0.26-0.62).

synapsesocial.com/papers/6acf695e3316c606f341f975 https://doi.org/10.1016/j.jacc.2025.07.057

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Safety and Efficacy of Intensive BP Control in Cardiovascular-Kidney-Metabolic Syndrome

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Safety and Efficacy of Intensive BP Control in Cardiovascular-Kidney-Metabolic Syndrome

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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