Cardiometabolic health and all-cause and cause-specific mortality in the general US adult population

Cardiometabolic health (CMH) holds potential prognostic value for long-term outcomes, highlighting the need for simple and cost effective tools that utilize modifiable variables to identify individuals at risk of mortality. This study aims to investigate the association between a CMH score derived from the Look AHEAD trial and mortality risk in the US population. Data were obtained from the National Health and Nutrition Examination Survey spanning 2005 to 2018, with mortality data linked through December 2019. The CMH score was calculated based on waist circumference, blood pressure, glomerular filtration rate, serum glycated hemoglobin, and urine albumin-to-creatinine ratio. Individuals were categorized into low (0–3), intermediate (4–5), and high (6–8) CMH groups. Multivariable Cox regression was used to explore the association between CMH score and mortality. The analysis included 31,884 US adults (mean age 47.2 years; 48.8% male). Over a mean follow-up of 7.56 years, there were 2,997 mortality events, including 906 CVD deaths, 732 cancer deaths, and 1,359 deaths from other causes. A higher CMH score was associated with a lower risk of all-cause mortality. The adjusted hazard ratios (aHR) for all-cause mortality events were 2.17 (95% confidence interval CI 1.88–2.52) and 1.36 (95% CI 1.20–1.53) in the low and intermediate CMH groups, respectively, compared to the high CMH group. Similar inverse associations were observed for mortality from cardiovascular disease, cancer, and other causes. The CMH score, utilizing simple and modifiable parameters, predicts the future risk of mortality in the US population. This simple and modifiable CMH scoring system offers a comprehensive assessment of cardiometabolic status and may serve as a practical tool for risk stratification in both clinical and public health settings.