Cardio-kidney-metabolic syndrome may accelerate CVD risk by up to 28 years
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Key takeaways:
- Cardio-kidney-metabolic (CKM) disease may accelerate risk for CVD events by up to 28 years for men and women.
- The American Heart Association’s PREVENT calculator may help risk stratify patients with CKM syndrome.
CHICAGO — Elevated risk for heart disease may arrive up to 28 years sooner for individuals with average risk factors plus diabetes and kidney disease vs. those without cardio-kidney-metabolic disease, a speaker reported.
A new study evaluating the prognostic efficacy of the PREVENT equations in a hypothetical adult cohort was presented at the American Heart Association Scientific Sessions.
“The goal of our study was to improve understanding of the novel PREVENT equations by simulating different risk profiles across the spectrum of age and cardiovascular-kidney-metabolic risk factors,” Vaishnavi Krishnan, BS, researcher at Northwestern University and a medical student at Boston University School of Medicine, told Healio. “Understanding how the model works, including what combinations and levels of different risk factors lead to higher predicted risk, can support clinicians and patients in interpreting risk calculator outputs.”
As Healio previously reported, the PREVENT equation, which was announced in November 2023, was derived using real-world contemporary datasets and included more than 6 million adults. The PREVENT calculator includes risk for MI, stroke and HF; excludes race from CVD clinical care algorithms; includes kidney function on top of traditional CVD risk factors; and includes components such as social determinants of health, serum glucose and kidney function.
For the present study, Krishnan and colleagues applied the PREVENT equations to a hypothetical cohort across the age and “cardio-kidney-metabolic” risk spectrum to estimate 10-year predicted risk for total CVD, including atherosclerotic CVD and HF.
The AHA coined the term cardiovascular-kidney-metabolic (CKM) syndrome to better describe the link between metabolic, renal risk factors and CVD risk, as Healio previously reported.
The equations were first applied to a hypothetical cohort of individuals aged 30 to 79 years with average population risk factor levels based on National Health and Nutrition Examination Survey 2011 to 2020 survey data; the hypothetical participants did not have diabetes, smoke or use antihypertensive drugs or statins.
The researchers then estimated age at which a hypothetical individual would exceed the intermediate risk threshold and tested for differences based on baseline diabetes and/or stage 3 chronic kidney disease (CKD) status, defined as estimated glomerular filtration rate of 44.5 mL/min/1.73 m2.
“We wanted to be able to demonstrate the full distribution of risk estimates with PREVENT, and the best way to do this is with a simulated approach by varying individual risk factors. However, the accuracy of the model in real-world cohorts has been studied elsewhere,” Krishnan told Healio. “Familiarity with how the model works is important foundational work before implementation in clinical practice, but future guidelines will need to consider how the PREVENT equations should be applied.”
In the first analysis, the estimated age to reach intermediate CVD risk was 68 years for women and 63 years for men in the hypothetical cohort.
Among adults with stage 3 CKD without diabetes, the age when 10-year CVD risk reached intermediate levels was reduced 8 years to age 60 years for women and age 55 years for men, according to the presentation.
Among adults with diabetes without stage 3 CKD, the estimated age when 10-year CVD risk reached intermediate levels was reduced 9 years to age 59 years for women and reduced 11 years to age 52 years for men, compared to those without CKM syndrome.
Among adults with both diabetes and stage 3 CKD, the estimated age when 10-year CVD risk reached intermediated levels was reduced 26 years to age 42 years for women and reduced 28 years to age 35 years for men, according to the presentation.
“Our study demonstrated the range of predicted risk estimates with PREVENT across a variety of risk factors and age. Specifically, individuals with diabetes or kidney disease are at a much higher risk for CVD even at a younger age in their 30s — which is now possible to calculate with the PREVENT equations,” Krishnan told Healio. “This allows more granular risk estimation among individuals who may not have been adequately captured by prior risk assessment tools like the Pooled Cohort Equations, including younger individuals and those with risk factors for kidney disease.”
Editor’s note: This article was updated on Dec. 10, 2024 to correct errors in how many years earlier risk thresholds would be met for women vs. men. The Editors regret the error.
Reference:
- Heart disease could hit up to 28 years sooner for people with CKM syndrome. https://newsroom.heart.org/news/heart-disease-could-hit-up-to-28-years-sooner-for-people-with-ckm-syndrome. Published Nov. 11, 2024. Accessed Dec. 9, 2024.
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Krishnan V. Abstract 1576. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
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