DOI: 10.1161/jaha.126.053440 ISSN: 2047-9980

Contemporary Burden, Drivers, and Risk‐Factor Control Gaps Across Cardiovascular–Kidney–Metabolic Syndrome Stages in US Adults, 2021 to 2023

Sangho Hyun, Chia‐hung Sze, Tughral Khan, John Iwaniec, Sana Khan, Anas Bizanti
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Background

Cardiovascular–kidney–metabolic (CKM) syndrome staging integrates adiposity, metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Contemporary national estimates of CKM stage distribution, stage drivers, and treatment gaps are needed to inform implementation of the CKM framework.

Methods

We analyzed adults aged ≥20 years in the National Health and Nutrition Examination Survey 2021 to 2023 fasting subsample. CKM stage was assigned hierarchically using American Heart Association CKM staging criteria. We estimated survey‐weighted CKM stage prevalence, national population counts, stage‐specific drivers, and risk‐factor control and treatment gaps across stages 2 through 4.

Results

The analytic sample included 2958 adults, representing 245.2 million US adults. Overall, 26.4 million adults (10.8%) were stage 0, 56.8 million (23.2%) stage 1, 125.9 million (51.3%) stage 2, 13.4 million (5.5%) stage 3, and 22.7 million (9.3%) stage 4. Stage ≥1 was present in 89.2%, stage ≥2 in 66.1%, and advanced CKM (stages 3–4) in 14.7%. Among stage 1 adults, 85.1% had adiposity and 49.2% had prediabetes. Among adults with stage 2 CKM, hypertension (72.0%), metabolic syndrome (56.1%), and hypertriglyceridemia (41.9%) were common drivers. Among adults with stage 3 CKM, 95.8% met the Predicting Risk of Cardiovascular Disease Events 10‐year cardiovascular disease risk criterion. Risk‐factor control and treatment gaps were common across stages 2 through 4, including blood pressure ≥130/80 mm Hg in 50.3% to 66.9%, lipid‐lowering therapy nonuse among eligible adults in 30.1% to 59.2%, and low‐density lipoprotein cholesterol above the target in 64.5% to 73.9%.

Conclusions

CKM syndrome affects most US adults, with stage‐specific drivers and persistent risk‐factor control and treatment gaps. These findings provide contemporary benchmarks for CKM surveillance and implementation.

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