Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome is a novel staging framework used to evaluate CKM health. Burden of CKM syndrome in China is relatively unknown, and such data may inform future health priority.
Objective: To assess the prevalence and mortality risk across CKM stages.
Methods: Nationally representative populations (n=33,685) were included from China Hypertension Survey. Weighted prevalence of each CKM stage was calculated. All-cause, cardiovascular (CV), and non-CV death associated with CKM stages were analyzed using Cox regression analysis. Population attributable fraction (PAF) was calculated to estimate the mortality burden related to each CKM stage.
Results: Between 2012 and 2015, 18.8% of Chinese adults met criteria for stage 0, 15.5% for stage 1, 42.1% for stage 2, 14.7% for stage 3, and 8.9% for stage 4, with advanced stage (stages 3-4) was 23.6%. After 5-year follow-up, compared to stage 0, adjusted hazard ratio (HR) for all-cause death in stage 1 was 0.77 (95% CI 0.51-1.15), stage 2 was 1.36 (95% CI 1.04-1.77), stage 3 was 2.47 (95% CI 1.91-3.19), and stage 4 was 4.00 (95% CI 3.07-5.22). Similarly, adjusted HRs for CV death and non-CV death progressively increased from stage 2 to stage 4 (both P-trend values < 0.001). For all-cause, CV, and non-CV death, PAFs increased with advancing CKM stages. For instance, for all-cause death, PAFs due to stage 2, 3, and 4 were 13.4%, 18.6%, and 22.0%.
Conclusion: Poor CKM health is widespread in China, underscoring the urgent need for collaborative and comprehensive management strategies to tackle CKM syndrome epidemic.
Editors
JACC: Asia Editor-in-Chief
Jian’an Wang, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD
Author
Aniruddha Singh, MD, FACC
Important Dates
Date of Release: July 1, 2025
Term of Approval/Date of CME/MOC Expiration: June 30, 2026