Impact of Cardiovascular-Kidney-Metabolic Burden on Echocardiographic Remodeling and Cardiovascular Outcomes in Hypertension
- 1Seoul National University Bundang Hospital
Abstract
AimsCardiovascular-kidney-metabolic (CKM) syndrome highlights the interrelationship between metabolic, renal, and cardiovascular disorders. However, whether CKM burden influences longitudinal cardiac structural and functional recovery and subsequent cardiovascular outcomes remains unclear.
MethodsWe studied 1,600 patients from the STRATS-HHD registry who underwent echocardiography at baseline and 6-18 months after treatment initiation. CKM burden was defined by obesity, diabetes, chronic kidney disease, and severe hypertension (0-1, 2, or [≥]3 components). The primary outcome was cardiovascular death or heart failure hospitalization (HHF).
ResultsCKM burden was 0-1 in 973 patients (60.8%), 2 in 440 (27.5%), and [≥]3 in 187 (11.7%). Higher burden was associated with worse baseline cardiac abnormalities and increased primary outcome risk (adjusted HR, 3.09; 95% CI, 1.92-4.98 for [≥]3 vs 0-1; adjusted HR, 1.53; 95% CI, 1.27-1.84 per +1 CKM component). The prognostic association persisted after additional adjustment for hepatic steatosis index-defined metabolic dysfunction-associated steatotic liver disease. Despite overall improvement in most echocardiographic parameters after treatment, patients with CKM burden [≥]3 showed less favorable E/e', LV global longitudinal strain (GLS), and LA stiffness index at follow-up. Normalization of these parameters at follow-up was associated with substantially lower subsequent cardiovascular risk. Mediation analyses suggested that echocardiographic abnormalities partially mediated the association between high CKM burden and the primary outcome.
ConclusionCKM burden identifies hypertensive patients with less favorable cardiac function after treatment and increased cardiovascular risk. These findings highlight the association of CKM burden with cardiac functional recovery and prognosis in patients with hypertension.
Graphical AbstractIn patients with hypertension, higher CKM burden was associated with more pronounced cardiac abnormalities, less favorable cardiac functional status after antihypertensive treatment, and increased cardiovascular risk. Normalization of functional echocardiographic parameters was associated with lower subsequent cardiovascular risk.
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/26366110v1_ufig1.gif" ALT="Figure 1"> View larger version (37K): [email protected]@b8d335org.highwire.dtl.DTLVardef@326807org.highwire.dtl.DTLVardef@14bbd50_HPS_FORMAT_FIGEXP M_FIG C_FIG
Related
- Comparative Cardiovascular Outcomes of Fimasartan and Calcium Channel Blockers in Hypertension: A Nationwide 3-Year Follow-Up Cohort Study
- First recorded hypertension and subsequent cardiovascular and kidney outcomes after newly diagnosed type 2 diabetes: a population-based cohort study
- Subclinical Cardiovascular Adaptation in Uncomplicated Monochorionic Twin Pregnancies: Echocardiographic and Cardiac Biomarker Findings
- Automatic transesophageal echocardiographic evaluation of patients with mitral valve prolapse: comparison with patients without structural cardiac chamber remodeling (an exploratory study)
- Nutritional Strategies for Selected MASLD Outcomes: Metabolic Remodeling, Liver-Aging Biomarkers, and Public Health Priorities
BibTeX
@misc{kim2026impact,
title = {{Impact of Cardiovascular-Kidney-Metabolic Burden on Echocardiographic Remodeling and Cardiovascular Outcomes in Hypertension}},
author = {H. M. Kim and M. Bak and J. Park and H.-M. Choi and Y. E. Yoon and G.-Y. Cho and I.-C. Hwang},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.21.26366110},
url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26366110v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Impact of Cardiovascular-Kidney-Metabolic Burden on Echocardiographic Remodeling and Cardiovascular Outcomes in Hypertension
AU - H. M. Kim
AU - M. Bak
AU - J. Park
AU - H.-M. Choi
AU - Y. E. Yoon
AU - G.-Y. Cho
AU - I.-C. Hwang
PY - 2026
DA - 2026/10/21
PB - medRxiv
DO - 10.64898/2026.10.21.26366110
UR - https://www.medrxiv.org/content/10.64898/2026.10.21.26366110v1
AB - AimsCardiovascular-kidney-metabolic (CKM) syndrome highlights the interrelationship between metabolic, renal, and cardiovascular disorders. However, whether CKM burden influences longitudinal cardiac structural and functional recovery and subsequent cardiovascular outcomes remains unclear. MethodsWe studied 1,600 patients from the STRATS-HHD registry who underwent echocardiography at baseline and 6-18 months after treatment initiation. CKM burden was defined by obesity, diabetes, chronic kidney disease, and severe hypertension (0-1, 2, or [≥]3 components). The primary outcome was cardiovascular death or heart failure hospitalization (HHF). ResultsCKM burden was 0-1 in 973 patients (60.8%), 2 in 440 (27.5%), and [≥]3 in 187 (11.7%). Higher burden was associated with worse baseline cardiac abnormalities and increased primary outcome risk (adjusted HR, 3.09; 95% CI, 1.92-4.98 for [≥]3 vs 0-1; adjusted HR, 1.53; 95% CI, 1.27-1.84 per +1 CKM component). The prognostic association persisted after additional adjustment for hepatic steatosis index-defined metabolic dysfunction-associated steatotic liver disease. Despite overall improvement in most echocardiographic parameters after treatment, patients with CKM burden [≥]3 showed less favorable E/e', LV global longitudinal strain (GLS), and LA stiffness index at follow-up. Normalization of these parameters at follow-up was associated with substantially lower subsequent cardiovascular risk. Mediation analyses suggested that echocardiographic abnormalities partially mediated the association between high CKM burden and the primary outcome. ConclusionCKM burden identifies hypertensive patients with less favorable cardiac function after treatment and increased cardiovascular risk. These findings highlight the association of CKM burden with cardiac functional recovery and prognosis in patients with hypertension. Graphical AbstractIn patients with hypertension, higher CKM burden was associated with more pronounced cardiac abnormalities, less favorable cardiac functional status after antihypertensive treatment, and increased cardiovascular risk. Normalization of functional echocardiographic parameters was associated with lower subsequent cardiovascular risk. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/26366110v1_ufig1.gif" ALT="Figure 1"> View larger version (37K): [email protected]@b8d335org.highwire.dtl.DTLVardef@326807org.highwire.dtl.DTLVardef@14bbd50_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -