Contemporary Burden, Drivers, and Risk‐Factor Control Gaps Across Cardiovascular–Kidney–Metabolic Syndrome Stages in US Adults, 2021 to 2023
- 1Lakeland Regional Health Medical Center
Abstract
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome staging integrates adiposity, metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Contemporary national estimates of CKM stage distribution, stage drivers, and treatment gaps are needed to inform implementation of the CKM framework. METHODS: We analyzed adults aged ≥20 years in the National Health and Nutrition Examination Survey 2021 to 2023 fasting subsample. CKM stage was assigned hierarchically using American Heart Association CKM staging criteria. We estimated survey-weighted CKM stage prevalence, national population counts, stage-specific drivers, and risk-factor control and treatment gaps across stages 2 through 4. RESULTS: The analytic sample included 2958 adults, representing 245.2 million US adults. Overall, 26.4 million adults (10.8%) were stage 0, 56.8 million (23.2%) stage 1, 125.9 million (51.3%) stage 2, 13.4 million (5.5%) stage 3, and 22.7 million (9.3%) stage 4. Stage ≥1 was present in 89.2%, stage ≥2 in 66.1%, and advanced CKM (stages 3-4) in 14.7%. Among stage 1 adults, 85.1% had adiposity and 49.2% had prediabetes. Among adults with stage 2 CKM, hypertension (72.0%), metabolic syndrome (56.1%), and hypertriglyceridemia (41.9%) were common drivers. Among adults with stage 3 CKM, 95.8% met the Predicting Risk of Cardiovascular Disease Events 10-year cardiovascular disease risk criterion. Risk-factor control and treatment gaps were common across stages 2 through 4, including blood pressure ≥130/80 mm Hg in 50.3% to 66.9%, lipid-lowering therapy nonuse among eligible adults in 30.1% to 59.2%, and low-density lipoprotein cholesterol above the target in 64.5% to 73.9%. CONCLUSIONS: CKM syndrome affects most US adults, with stage-specific drivers and persistent risk-factor control and treatment gaps. These findings provide contemporary benchmarks for CKM surveillance and implementation.
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BibTeX
@article{hyun2026contemporary,
title = {{Contemporary Burden, Drivers, and Risk‐Factor Control Gaps Across Cardiovascular–Kidney–Metabolic Syndrome Stages in US Adults, 2021 to 2023}},
author = {Sangho Hyun and Chia‐hung Sze and Tughral Khan and John Iwaniec and Sana Khan and Anas Bizanti},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.053440},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.053440},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Contemporary Burden, Drivers, and Risk‐Factor Control Gaps Across Cardiovascular–Kidney–Metabolic Syndrome Stages in US Adults, 2021 to 2023
AU - Sangho Hyun
AU - Chia‐hung Sze
AU - Tughral Khan
AU - John Iwaniec
AU - Sana Khan
AU - Anas Bizanti
PY - 2026
DA - 2026/10/23
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.053440
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.053440
AB - BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome staging integrates adiposity, metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Contemporary national estimates of CKM stage distribution, stage drivers, and treatment gaps are needed to inform implementation of the CKM framework. METHODS: We analyzed adults aged ≥20 years in the National Health and Nutrition Examination Survey 2021 to 2023 fasting subsample. CKM stage was assigned hierarchically using American Heart Association CKM staging criteria. We estimated survey-weighted CKM stage prevalence, national population counts, stage-specific drivers, and risk-factor control and treatment gaps across stages 2 through 4. RESULTS: The analytic sample included 2958 adults, representing 245.2 million US adults. Overall, 26.4 million adults (10.8%) were stage 0, 56.8 million (23.2%) stage 1, 125.9 million (51.3%) stage 2, 13.4 million (5.5%) stage 3, and 22.7 million (9.3%) stage 4. Stage ≥1 was present in 89.2%, stage ≥2 in 66.1%, and advanced CKM (stages 3-4) in 14.7%. Among stage 1 adults, 85.1% had adiposity and 49.2% had prediabetes. Among adults with stage 2 CKM, hypertension (72.0%), metabolic syndrome (56.1%), and hypertriglyceridemia (41.9%) were common drivers. Among adults with stage 3 CKM, 95.8% met the Predicting Risk of Cardiovascular Disease Events 10-year cardiovascular disease risk criterion. Risk-factor control and treatment gaps were common across stages 2 through 4, including blood pressure ≥130/80 mm Hg in 50.3% to 66.9%, lipid-lowering therapy nonuse among eligible adults in 30.1% to 59.2%, and low-density lipoprotein cholesterol above the target in 64.5% to 73.9%. CONCLUSIONS: CKM syndrome affects most US adults, with stage-specific drivers and persistent risk-factor control and treatment gaps. These findings provide contemporary benchmarks for CKM surveillance and implementation.
SN - 2047-9980
ER -