Clinical Scorecard: Mortality Associated with Cardiovascular-Kidney-Metabolic Syndrome in a Prospective Study from the UK

At a Glance

Key Highlights

• CKM syndrome stages 2–4 are strongly associated with increased all-cause and cardiovascular mortality in both sexes.
• Stage 1 CKM (excess/dysfunctional adiposity without metabolic sequelae) is not significantly associated with increased mortality risk compared to Stage 0.
• Mortality relative risk is higher in females, but absolute risk increases with CKM stage are greater in males.

Guideline-Based Recommendations

Diagnosis

• Classify CKM syndrome stages 0–4 based on AHA framework using clinical, laboratory, and risk equivalent data.
• Adapt Stage 3 classification using very high-risk CKD criteria and high predicted 10-year CVD risk scores when cardiac biomarkers are unavailable.

Management

• Early treatment of obesity to prevent progression to metabolic sequelae defining higher CKM stages.
• Implement disease-modifying therapies targeting overlapping CKM indications.

Monitoring & Follow-up

• Longitudinal follow-up for mortality outcomes and cardiovascular events.
• Use risk stratification tools such as PREVENT score and KDIGO CKD risk categories.

Risks

• Higher CKM stages confer increased risk of all-cause and cardiovascular mortality.
• Sex differences in risk magnitude and absolute mortality should be considered in management.

Patient & Prescribing Data

Middle-aged adults (40–69 years) from a largely White UK cohort with varying CKM stages

Focus on preventing progression from Stage 1 to higher CKM stages through metabolic risk factor control; recognize that Stage 2+ CKM indicates elevated mortality risk warranting targeted interventions.

Clinical Best Practices

• Utilize comprehensive phenotyping and risk scoring to classify CKM syndrome accurately.
• Recognize the prognostic importance of CKM stages 2 and above for mortality risk stratification.
• Consider sex-specific differences in relative and absolute risk when planning patient management.
• Address obesity early to prevent development of metabolic complications that increase mortality risk.

References

• American Heart Association CKM Syndrome Statement 2023
• KDIGO 2012 Clinical Practice Guideline for CKD
• PREVENT Cardiovascular Risk Score