Progression of Cardiovascular-Kidney-Metabolic Syndrome among Hispanic/Latino Adults in the United States: The Hispanic Community Health Study/Study of Latinos.

Abstract

Key points: Eight in ten Hispanic/Latino adults had cardiovascular-kidney-metabolic risk factors or subclinical cardiovascular disease at baseline, with differences by sex and background group. Over 6 years, one in ten regressed to a lower cardiovascular-kidney-metabolic stage while one in five progressed to a higher cardiovascular-kidney-metabolic stage. Higher baseline cardiovascular-kidney-metabolic stage was associated with progressively greater risk of incident cardiovascular disease over 11.4 years.

Background: Cardiovascular-kidney-metabolic (CKM) syndrome describes the clustering of risk factors and progression of disease at the intersection of metabolic disorders, CKD, and cardiovascular disease (CVD). The aim of this study was to characterize the prevalence of CKM stages and progression of CKM syndrome among diverse US Hispanic/Latino adults.

Methods: The Hispanic Community Health Study/Study of Latinos is a population-based longitudinal cohort of 16,415 Hispanic/Latino adults aged 18-74 years from four US communities. Participants completed examinations at visit 1 (V1, 2008-2011) and visit 2 (2014-2017). Data collected included body mass index, waist circumference, glucose tolerance, lipids, BP, metabolic syndrome, CKD, 10-year CVD risk (to define subclinical CVD), and clinical CVD. CKM stages were defined using American Heart Association criteria: stage 0 (no CKM risk factors), stage 1 (excess/dysfunctional adiposity), stage 2 (metabolic risk factors or CKD), stage 3 (subclinical CVD or risk equivalents), and stage 4 (clinical CVD). We estimated the age-standardized prevalence of CKM stages at V1 ( n =16,123) and CKM stage progression from V1 to visit 2 ( n =11,178). All analyses were weighted and accounted for the Hispanic Community Health Study/Study of Latinos complex survey design.

Results: At V1, the mean age was 41.1 years, and 52.3% were female. The distribution of CKM stages was as follows: stage 0, 10.6% (SEM, 0.4); stage 1, 26.1% (SEM, 0.6); stage 2, 50.6% (SEM, 0.6); stage 3, 2.4% (SEM, 0.2); and stage 4, 10.3% (SEM, 0.3). Over an average follow-up of 6 years, 10.3% (SEM, 0.5) regressed to a lower CKM stage, while 21.5% (SEM, 0.7) progressed to a higher CKM stage.

Conclusions: Among diverse US Hispanic/Latino adults, eight in ten had CKM risk factors or subclinical CVD and one in five experienced CKM progression over 6 years. These findings highlight the need for targeted, early-stage interventions to prevent CKM progression and improve CKM health in Hispanic/Latino populations.