Vascular Aging, Cardiovascular-Kidney-Metabolic Syndrome, and Cardiovascular Risk: The Northern Shanghai Study.

BACKGROUND: The role of vascular aging in cardiovascular-kidney-metabolic (CKM) syndrome and its associated cardiovascular risk remains unclear. OBJECTIVES: This study aims to explore the relationship between CKM syndrome, vascular aging, and cardiovascular risk. METHODS: This analysis was based on the Northern Shanghai Study (2013-2022), a prospective study of community-dwelling elderly Chinese. CKM syndrome was classified into 5 stages (0-4) according to the American Heart Association's presidential advisory. Participants with cardiovascular disease (ie, CKM stage 4) were excluded. Vascular aging was defined as a carotid-femoral pulse wave velocity≥10 m/s. Multivariable-adjusted Cox proportional hazard models were used to evaluate the associations of CKM syndrome and vascular aging with incident major adverse cardiovascular events (MACEs). RESULTS: Among 2,584 participants (mean age, 70.8 ± 5.6 years; 42.7% men), 748 (42.6%) were in advanced CKM syndrome stage (ie, stage 3), 52.5% of whom exhibited vascular aging. Over a median follow-up of 5.42 years, 132 individuals (5.1%) experienced incident MACEs. After adjustments, advanced CKM syndrome was positively associated with an increased risk of MACEs (HR: 2.44; 95% CI: 1.46-4.08), with this association being more pronounced in participants exhibiting vascular aging (HR: 5.19 vs 1.82; P for interaction = 0.039). Compared to early CKM syndrome, advanced CKM syndrome was positively associated with a progressively higher hazard of MACEs, which became markedly elevated at a carotid-femoral pulse wave velocity of approximately 10 m/s onward (ie, vascular aging). CONCLUSIONS: CKM syndrome and vascular aging were jointly associated with cardiovascular risk. Vascular aging may provide important pathophysiological insights into elevated cardiovascular risk in advanced CKM syndrome. (Prognosis in the Elderly Chinese: the Northern Shanghai Study [NSS]; NCT02368938).