Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages
- 1The 72nd Group Army Hospital
Abstract
Background The 2023 American Heart Association cardiovascular-kidney-metabolic (CKM) staging framework supports risk stratification, but evidence on guideline-level physical activity across stages remains limited. Methods We emulated a target-trial protocol using NHANES 2007-2018 and National Death Index linkage through December 31, 2019. Adults aged 20 to 79 years with CKM stages 1 to 4, estimated glomerular filtration rate of at least 15 mL/min/1.73 m2, complete activity data, no cancer history, and eligible follow-up were included. Baseline activity was classified as meeting or not meeting the guideline. Within-stage propensity-score weights were used in weighted Cox models. All-cause and cardiovascular mortality were the primary and secondary outcomes; 5-year risks used weighted survival curves, with competing-risk cumulative incidence also estimated for cardiovascular mortality. Results Among 19,654 participants, 1,190 all-cause deaths occurred during 134,037 person-years. Baseline attainment was associated with lower all-cause mortality overall (HR, 0.774; 95% CI, 0.675-0.888). Stage-specific HRs were 1.030, 0.803, 0.642, and 0.727 for stages 1 to 4, respectively; estimates were nonmonotonic. Five-year risk differences were +0.040, -0.830, -1.790, and -3.840 percentage points; only the stage 4 interval excluded the null. Cardiovascular mortality showed a similar overall cause-specific association (HR, 0.707; 95% CI, 0.547-0.914). Conclusions Observed baseline guideline attainment was associated with mortality in this observational target-trial emulation. The findings are consistent with current physical activity recommendations but do not estimate the effect of an activity-promotion intervention; prospective trials are needed to establish clinical benefit.
Related
- 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome
- Association of sleep time with all-cause and cardiovascular mortality among individuals with advanced cardiovascular-kidney-metabolic syndrome : A NHANES-based prospective cohort study
- Machine learning based predictive model for cardiovascular disease mortality risk in patients with stage 4 cardiovascular–kidney–metabolic syndrome
- Heavy metal exposure and risk of all-cause and cardiovascular mortality in population with cardiovascular-kidney-metabolic syndrome stage 0–3: a cohort study
- The cardiovascular–liver–metabolic syndemic and mortality and life expectancy: two prospective cohort studies
BibTeX
@misc{luo2026baseline,
title = {{Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages}},
author = {X. Luo and Y. Wang and W. Zhou and F. Yu and J. Sun and K.-F. Xiang and F. Wang and Z. Yuan and J. Bao and S. Zhang and Y. Zheng and F. Wu},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.28.26366776},
url = {https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages
AU - X. Luo
AU - Y. Wang
AU - W. Zhou
AU - F. Yu
AU - J. Sun
AU - K.-F. Xiang
AU - F. Wang
AU - Z. Yuan
AU - J. Bao
AU - S. Zhang
AU - Y. Zheng
AU - F. Wu
PY - 2026
DA - 2026/10/28
PB - medRxiv
DO - 10.64898/2026.10.28.26366776
UR - https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1
AB - Background The 2023 American Heart Association cardiovascular-kidney-metabolic (CKM) staging framework supports risk stratification, but evidence on guideline-level physical activity across stages remains limited. Methods We emulated a target-trial protocol using NHANES 2007-2018 and National Death Index linkage through December 31, 2019. Adults aged 20 to 79 years with CKM stages 1 to 4, estimated glomerular filtration rate of at least 15 mL/min/1.73 m2, complete activity data, no cancer history, and eligible follow-up were included. Baseline activity was classified as meeting or not meeting the guideline. Within-stage propensity-score weights were used in weighted Cox models. All-cause and cardiovascular mortality were the primary and secondary outcomes; 5-year risks used weighted survival curves, with competing-risk cumulative incidence also estimated for cardiovascular mortality. Results Among 19,654 participants, 1,190 all-cause deaths occurred during 134,037 person-years. Baseline attainment was associated with lower all-cause mortality overall (HR, 0.774; 95% CI, 0.675-0.888). Stage-specific HRs were 1.030, 0.803, 0.642, and 0.727 for stages 1 to 4, respectively; estimates were nonmonotonic. Five-year risk differences were +0.040, -0.830, -1.790, and -3.840 percentage points; only the stage 4 interval excluded the null. Cardiovascular mortality showed a similar overall cause-specific association (HR, 0.707; 95% CI, 0.547-0.914). Conclusions Observed baseline guideline attainment was associated with mortality in this observational target-trial emulation. The findings are consistent with current physical activity recommendations but do not estimate the effect of an activity-promotion intervention; prospective trials are needed to establish clinical benefit.
ER -