Research Square · Oct 28, 2026
Lifestyle factors and progression from stage 2/3 to stage 4 cardiovascular-kidney-metabolic (CKM) syndrome in older adults: a cohort study
By Wang R, Fan W, Wong ND et al.
Background : Cardiovascular–kidney–metabolic (CKM) syndrome provides an integrated framework for cardiometabolic and renal disease progression, yet the role of modifiable lifestyle factors in advancing to overt clinical disease remains incompletely characterized. Methods : We analyzed data from the Cardiovascular Health Study, a population-based cohort of U.S. adults aged ≥65 years. Participants with CKM stage 2 or 3 at baseline were followed for progression to stage 4 CKM, defined by incident clinical cardiovascular disease. Lifestyle exposures included physical activity, walking characteristics, household and leisure activities, smoking, sleep conditions, diet quality, and an overall Life’s Essential 8 (LE8)–based cardiovascular health index. Cox proportional hazards models estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results : Among 2,493 participants, greater physical activity was consistently associated with lower risk of CKM progression. Compared with no activity, low- and moderate-intensity activity were associated with reduced hazards (HR=0.71, 95% CI: 0.58-0.89 and HR=0.68, 95% CI: 0.55-0.86, respectively). Walking, faster walking pace, household chores, and gardening were inversely associated with progression. Heavy smoking (≥35 pack-years) was associated with higher risk, whereas sleep disturbances and sleep apnea were not. Higher LE8 index scores were strongly associated with lower risk; participants with ideal scores had a 45% lower hazard compared with those with poor scores (HR=0.55, 95% CI: 0.40-0.75). Conclusion : Among older adults with intermediate-stage CKM, regular physical activity and overall cardiovascular health were strongly associated with lower risk of progression to overt clinical disease, highlighting the importance of comprehensive lifestyle and risk factor optimization.