Key result
Three CKM comorbidities linked to ~2.1-fold higher post-AMI mortality regardless of weight.
Why the study?
Although excess body mass is widely considered characteristic of cardiovascular-kidney-metabolic (CKM) syndrome, cases also occur in lean or normal-weight individuals. The mortality risk in AMI patients stratified by both overweight status and CKM comorbidities (AMI, hyperglycemia, and renal insufficiency) required evaluation.
Cohort (n=21,351)
Yes
In patients with acute myocardial infarction, having multiple cardiovascular-kidney-metabolic comorbidities (diabetes and chronic kidney disease) significantly increases 2-year mortality risk regardless of overweight status, particularly in younger individuals (≤65 years).
Background Cardiovascular-kidney-metabolic (CKM) syndrome has aroused widespread interest in interactions between diabetes, chronic kidney disease (CKD), and cardiovascular disease. The prevailing opinion among is that excess body mass is a characteristic of CKM patients, though cases have also been identified in individuals with lean/normal-weight. This study aimed to analyze the mortality risk in people with AMI according to the presence of overweight and comorbidities (AMI, hyperglycemia, renal insufficiency) in a Chinese cohort. Methods The China Acute Myocardial Infarction registry is a prospective, nationwide, multicenter study including AMI patients from 108 three-level hospitals throughout mainland China. Overweight is categorized by BMI (≥28.0 kg/m2) according to Chinese guidelines. Individuals enrolled were divided into 6 categories according to the presence of different clinical comorbidities: (i) Group 1: overweight with AMI; (ii) Group 2: overweight with 2 CKM comorbidities; (iii) Group 3: overweight with 3 CKM comorbidities; (iv) Group 4: non-overweight with AMI; (v) Group 5: non-overweight with 2 CKM comorbidities; and (vi) Group 6: non-overweight with 3 CKM comorbidities. The primary outcome was 2-year all-cause death after AMI. Results 21,351 people with AMI were included [mean age 52±12 years, 74.2% males], and death events occurred in 2,547 cases. Both overweight and non-overweight people with 3 CKM comorbidities were associated with a higher primary outcome (aHR=2.08, 95% CI: 1.62-2.67; and aHR= 2.45, 95% CI: 1.94-3.10, respectively). On interaction analysis, the impact of CKM comorbidities on mortality rate was consistent in overweight and non-overweight individuals (P for interaction=0.697), but more pronounced in individuals aged ≤ 65 years compared to older adults (P for interaction <0.001). Conclusion This study elucidates a more severe manifestation of CKM syndrome, AMI complicated by diabetes and CKD, which is more pronounced in younger while regardless of obesity status.
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Liu et al. (2026) conducted a cohort in Acute myocardial infarction (n=21,351). Cardiovascular-kidney-metabolic (CKM) comorbidities (AMI, hyperglycemia, renal insufficiency) and overweight status (BMI ≥28.0 kg/m2) vs. Fewer CKM comorbidities (AMI alone) stratified by overweight status was evaluated on 2-year all-cause death after AMI (aHR 2.08 (overweight with 3 CKM comorbidities); aHR 2.45 (non-overweight with 3 CKM comorbidities), 95% CI 1.62-2.67). Having 3 CKM comorbidities increased 2-year all-cause mortality after AMI in both overweight (aHR 2.08, 95% CI 1.62-2.67) and non-overweight patients (aHR 2.45, 95% CI 1.94-3.10).
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