More advanced cardiovascular-kidney-metabolic syndrome stages were associated with lower cardiovascular health scores and greater evidence of early carotid arterial injury among young adults, according to a cross-sectional study.
Investigators analyzed 1,283 participants with a mean age of 23 years who completed in-person examinations from 2021 to 2023 in the FF-CHAYA study.
They adapted the American Heart Association cardiovascular-kidney-metabolic (CKM) staging framework to classify participants as either stage 0 (no CKM risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (metabolic or kidney risk factors), or stage 3 (subclinical cardiovascular disease or high-risk equivalents). One participant with a self-reported history of cardiovascular disease was excluded.
Cardiovascular health was assessed using Life’s Essential 8 scores, ranging from 0 to 100 and calculated as the unweighted average of 8 metrics: diet quality, physical activity, sleep, nicotine exposure, body mass index, blood glycemia, blood lipids, and blood pressure. The participants underwent carotid ultrasonography to assess markers of early arterial injury and arterial stiffness. The investigators used multivariable linear regression models adjusted for age, self-identified gender, and self-identified race and ethnicity.
About 21% of the participants were classified as stage 0, 40% as stage 1, 36% as stage 2, and 3% as stage 3. Adjusted mean Life’s Essential 8 scores were 78 points in stage 0, 70 in stage 1, 64 in stage 2, and 64 in stage 3.
In a sensitivity analysis restricted to the health-behavior components of diet, physical activity, sleep, and nicotine exposure, scores did not differ statistically across CKM stages. The investigators noted that the lack of observed differences may have reflected the limited sensitivity of self-reported data for these measures.
More advanced CKM stages were associated with higher mean-mean and mean-maximum carotid intima-medial thickness and lower gray scale median. Mean-maximum carotid intima-medial thickness was 0.014 mm higher than stage 0 in stage 1, 0.020 mm higher in stage 2, and 0.100 mm higher in stage 3.
“These findings demonstrate that CKM stages are associated with early markers of carotid arterial injury as early as young adulthood,” wrote study author Vaishnavi Krishnan, BS, of the Section of Preventive Medicine & Epidemiology in the Department of Medicine at the Boston University Chobanian & Avedisian School of Medicine in Massachusetts, and colleagues.
Associations between CKM stages and Life’s Essential 8 scores were partly definitional. The investigators could not establish causality and testing several outcomes raised the possibility of chance findings. Because those from disadvantaged backgrounds were oversampled, the cohort may not be representative of young adults with different demographic compositions.
The study was supported by the National Heart, Lung, and Blood Institute; Princeton University; Northwestern University Feinberg School of Medicine; and an AHA student scholarship. Co-author Donald M. Lloyd-Jones, MD, ScM, serves as an unpaid fiduciary director of the American Heart Association. The study authors reported no other conflicts of interest.
