Population estimates, trends, characteristics and prognostic outcomes of cardiovascular-kidney-liver-metabolic health: A population-based study.
Cardiovascular-kidney-liver-metabolic (CKLM) diseases constitute the presence of MASLD, T2D, CKD, obesity and/or CVD, that often co-exist and synergistically increase cardiovascular risk. However, the prevalence, extent and outcomes of the CKLM burden remain poorly understood.
This population-based study utilised National Health and Nutrition Examination Survey (NHANES) 2007-2018 database, examining individuals' number (0-4) and permutations of CKLM diseases, namely: type 2 diabetes (T2D), obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD). The primary outcome was all-cause mortality. Cox regression models were constructed to evaluate the relationship between CKLM phenotypes and all-cause mortality, adjusting for age, sex, race, socioeconomic status, and physical activity.
The weighted cohort represented 97.8 million US adults (mean age 47.7 ± 16.7 years). 54.16% of the cohort had ≥1 CKLM diseases. From 2007 to 2018, the proportion of individuals with ≥2 CKLM diseases increased from 32.4% to 55.6% of the population, with the largest increase in proportion of individuals with 4 diseases. The most common CKLM phenotype was MASLD-obesity (23.0%), followed by MASLD-obesity-T2D (5.1%). The highest mortality rates were observed in individuals with 4 CKLM diseases (21.4%), followed by 3 diseases (12.2%). Cox regression revealed that 4 diseases predicted the highest mortality risk (aHR 2.24, 95%CI: 1.66-3.02, p < 0.001), followed by 3 diseases (aHR 1.52, 95%CI: 1.25-1.85, p < 0.001). The MASLD-T2D-CKD phenotype (aHR 3.13, 95%CI: 1.80-5.42, p < 0.001) and T2D-CKD phenotype (aHR 3.26, 95%CI: 2.33-4.55, p < 0.001) predicted the highest mortality risk.
The CKLM multimorbidity burden is rising in the US population. Higher CKLM burden (≥3 CKLM diseases) and CKD-centric phenotypes (MASLD-T2D-CKD or T2D-CKD) independently predict the highest mortality risk.
This population-based study utilised National Health and Nutrition Examination Survey (NHANES) 2007-2018 database, examining individuals' number (0-4) and permutations of CKLM diseases, namely: type 2 diabetes (T2D), obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD). The primary outcome was all-cause mortality. Cox regression models were constructed to evaluate the relationship between CKLM phenotypes and all-cause mortality, adjusting for age, sex, race, socioeconomic status, and physical activity.
The weighted cohort represented 97.8 million US adults (mean age 47.7 ± 16.7 years). 54.16% of the cohort had ≥1 CKLM diseases. From 2007 to 2018, the proportion of individuals with ≥2 CKLM diseases increased from 32.4% to 55.6% of the population, with the largest increase in proportion of individuals with 4 diseases. The most common CKLM phenotype was MASLD-obesity (23.0%), followed by MASLD-obesity-T2D (5.1%). The highest mortality rates were observed in individuals with 4 CKLM diseases (21.4%), followed by 3 diseases (12.2%). Cox regression revealed that 4 diseases predicted the highest mortality risk (aHR 2.24, 95%CI: 1.66-3.02, p < 0.001), followed by 3 diseases (aHR 1.52, 95%CI: 1.25-1.85, p < 0.001). The MASLD-T2D-CKD phenotype (aHR 3.13, 95%CI: 1.80-5.42, p < 0.001) and T2D-CKD phenotype (aHR 3.26, 95%CI: 2.33-4.55, p < 0.001) predicted the highest mortality risk.
The CKLM multimorbidity burden is rising in the US population. Higher CKLM burden (≥3 CKLM diseases) and CKD-centric phenotypes (MASLD-T2D-CKD or T2D-CKD) independently predict the highest mortality risk.
Authors
Chen Chen, Himan Himan, Yazicioglu Yazicioglu, Goh Goh, Chin Chin, Chong Chong, Nagarajan Nagarajan, Kueh Kueh, Wang Wang, Muthiah Muthiah, Zhou Zhou, Chan Chan, Mehta Mehta, Mamas Mamas, Khan Khan, Chew Chew
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