Association between Cardiovascular-Kidney-Metabolic Health and Early Arterial Injury in Young Adults in the United States: The Future of Families – Cardiovascular Health Among Young Adults Study

Abstract

Background: The American Heart Association (AHA) recently introduced the novel construct of Cardiovascular-Kidney-Metabolic (CKM) Syndrome, but it is unclear how the CKM staging construct applies to young adults and how it may correlate with cardiovascular health (CVH) status and carotid artery health. Methods: In the Future of Families – Cardiovascular Health Among Young Adults (FF-CHAYA) Study, we defined CKM stages using the AHA’s framework. CVH was measured by Life’s Essential 8 (LE8) scores (composite metric consisting of dietary quality, physical activity, sleep, nicotine exposure, body mass index, blood glycemia, blood lipids, blood pressure). We examined cross-sectional associations of CKM stages with LE8 scores and carotid ultrasonography measures using multivariable regression models adjusted for age, self-identified gender, and self-identified race/ethnicity. Results: Among 1283 FF-CHAYA participants (mean [standard deviation] age 22.9 [0.7] years, 54.4% women), 20.7% of participants were classified as Stage 0 CKM (no risk factors), 40.2% as Stage 1 CKM (excess adiposity), 36.2% as Stage 2 CKM (metabolic risk factors), and 2.8% as Stage 3 CKM (subclinical cardiovascular disease or advanced kidney disease). Compared to Stage 0, participants in Stages 1–3 had significantly lower LE8 scores (beta [95% confidence interval]: −7.6 [−9.4, −5.8] for Stage 1, −13.9 [−15.7, −12.0] for Stage 2, −13.2 [−17.4, −9.0] for Stage 3). Additionally, Stages 1–3 had significantly higher mean-mean and mean-maximum carotid intima-medial thickness (cIMT) and lower grey scale median compared to Stage 0. For example, mean-maximum cIMT was 0.014-mm higher (0.005, 0.020) for Stage 1, 0.020-mm higher (0.017, 0.035) for Stage 2, and 0.100-mm higher (0.085, 0.128) for Stage 3, compared to Stage 0. Conclusion: Among young adults, more advanced CKM stage was associated with worse CVH, including greater evidence of early arterial injury. These findings elucidate the need for earlier preventive efforts and population-level interventions to address upstream drivers of CKM health.