AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Cardiovascular, Kidney, and Metabolic (CKM) Staging and Risk of Mortality in the REGARDS Study
By Pinheiro L, Ringel J, Jumonville G et al.
Introduction: Cardiovascular, kidney, and metabolic (CKM) syndrome is an interconnected spectrum of obesity, diabetes, chronic kidney disease (CKD), and cardiovascular disease. In 2023, the American Heart Association established CKM staging to offer a novel, evidence-based approach to characterize cumulative cardiometabolic risk. Research Question: We sought to describe the CKM stages in a large, community-based cohort of adults across the US. Methods: We used data from the REasons for Geographic and Racial Disparities in Stroke (REGARDS) Study, a longitudinal cohort of 30,239 dwelling adults 45+ years across 48 states, recruited from 2003-7. We operationalized CKM staging as: stage 0 (no CKM risk factors), stage 1 (elevated BMI or waist circumference; no other metabolic risk factors), stage 2 (metabolic risk factors [diabetes, hypertriglyceridemia, hypertension] and or CKD), stage 3 (other metabolic risks, high risk CKD, or high predicted 10-year CVD risk), and stage 4 (clinical CVD, defined as: CHD, HF, PAD, or Afib, in individuals with excess or dysfunctional adiposity, other metabolic risk factors or CKD). Using descriptive statistics, we characterized participants by CKM stage. Kaplan-Meier curves were used to visually depict overall and CVD-specific mortality by CKM stage. Results: Among 30,183 adults in the REGARDS study, 1,045 (3.5%) were stage 0, 2,198 (7.3%) stage 1, 7,537 (25%) stage 2, 11,006 (36.5%) stage 3, and 8397 (27.8%) were stage 4 at baseline. Overall, REGARDS participants with higher CKM stage were older, had lower incomes, were less physically active, reported worse physical well-being and more depressive symptoms, and had higher PREVENT scores. Over a median follow-up of 13.4 years, we observed a significantly higher risk of overall mortality (HR 1.8 [95% CI 1.7-1.9]) and CVD-specific mortality (HR 2.7 ([2.5-3.0]) among those in stage 3 and 4 compared to stages 0, 1, and 2, adjusting for age, race and gender. Conclusion: Among a large, national cohort of Americans, higher stages of CKM syndrome were highly prevalent and associated with long-term risk of mortality. These findings underscore that sub-optimal CKM health is ubiquitous and there is an urgent need for more screening and management.