Background: The American Heart Association recently updated the Cardiovascular Kidney Metabolic (CKM) Health advisory, proposing a new framework for defining, staging, and predicting CKM risk. However, the prevalence and adverse effects of CKM stages remain insufficiently characterized. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) (1999 to 2018), including 18,350 US adults aged 20 to 79 years. CKM syndrome encompasses subclinical or clinical cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic risk factors. Participants were categorized into four CKM stages based on clinical severity. We assessed associations of CKM stages with mortality risk and life expectancy. Results: Only 12.9% of participants were classified as CKM stage 0. The prevalence of CKM stages 1, 2, 3, and 4 was 23.1%, 53.6%, 3.6%, and 6.7%, respectively. Compared to CKM stage 0, individuals in stage 4 had a markedly higher risk of all-cause mortality (HR: 4.30, 95% CI: 2.95 to 6.26) and lost 15.5 (12.5 to 19.8) years of life at age 50. Sex and racial/ethnic disparities were also observed. Conclusions: Higher CKM stages were strongly associated with increased mortality and reduced life expectancy. Our findings underscore the urgent need for enhanced CKM health management, social support, and policy interventions.

The authors have declared no competing interest.

This work was supported by the China Academy of Chinese Medical Sciences Innovation Fund for Medical Science [grant number 2021-I2M-1-009]. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors have full access to all the data in the study and have final responsibility for the decision to submit for publication.

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The National Health and Nutrition Examination Survey (NHANES) is a publicly available database approved by the National Center for Health Statistics institutional review board (Protocol #98-12, Protocol #2005-06, Continuation of Protocol #2005-06, Protocol #2011-17, Continuation of Protocol #2011-17, Protocol #2018-01). All participants provided written informed consent when they completed the national survey in the United States. Ethical review and approval were waived for this study since secondary analysis did not require additional institutional review board approval.

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