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Background <p>Advanced stages of cardiovascular-kidney-metabolic syndrome (CKMs) are associated with a markedly increased risk of mortality. However, the individual and combined effects of cortisol (COR) and aldosterone (ALD) on CKMs remain unclear. We aimed to investigate their separate and joint associations with CKMs stages and major components.</p> Method <p>This cross-sectional study included 8,781 participants to investigate the separate and joint associations of COR and ALD with CKMs and its components, using linear regression, logistic regression, restricted cubic spline analyses (RCS), interaction analyses, and stratified analyses.</p> Result <p>Beyond associations with CKMs staging-related continuous indicators and key components, higher quartiles of COR (Q4 vs. Q1, OR = 1.56, 95%CI, 1.26–1.95) and ALD (Q4 vs. Q1, OR = 1.33, 95%CI, 1.07–1.64) were independently associated with higher odds of advanced CKMs. RCS revealed significant nonlinear associations between log-transformed COR and ALD levels and advanced CKMs. A significant additive interaction was observed between COR and ALD on advanced CKMs (RERI = 0.94, 95%CI, 0.35–1.52; AP = 0.41, 95%CI, 0.30–0.52; S = 3.75, 95%CI, 1.84–7.63). Co-exposure analyses showed a 46% higher odds of advanced CKMs in the “High COR, High ALD” group (OR = 1.46, 95%CI, 1.19–1.80, <i>P</i> &lt; 0.001) compared to the “Low COR, Low ALD” group, with consistent trends across most subgroups.</p> Conclusion <p>Both COR and ALD show significant associations with advanced CKMs. The joint assessment of COR and ALD improves the identification of high-risk individuals, underscoring the value of adrenal hormone profiling in CKMs risk stratification.</p> Graphical abstract <p></p>

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Separate and joint associations of morning plasma cortisol and aldosterone with Cardiovascular - Kidney - Metabolic syndrome in Chinese Hakka adults

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Lingyu Ye,
  • Yezhou Wu,
  • Huannan Wei,
  • Xuefang Liang,
  • Jingwei Lin,
  • Shengzhu Huang,
  • Zengnan Mo,
  • Mingli Li

摘要

Background

Advanced stages of cardiovascular-kidney-metabolic syndrome (CKMs) are associated with a markedly increased risk of mortality. However, the individual and combined effects of cortisol (COR) and aldosterone (ALD) on CKMs remain unclear. We aimed to investigate their separate and joint associations with CKMs stages and major components.

Method

This cross-sectional study included 8,781 participants to investigate the separate and joint associations of COR and ALD with CKMs and its components, using linear regression, logistic regression, restricted cubic spline analyses (RCS), interaction analyses, and stratified analyses.

Result

Beyond associations with CKMs staging-related continuous indicators and key components, higher quartiles of COR (Q4 vs. Q1, OR = 1.56, 95%CI, 1.26–1.95) and ALD (Q4 vs. Q1, OR = 1.33, 95%CI, 1.07–1.64) were independently associated with higher odds of advanced CKMs. RCS revealed significant nonlinear associations between log-transformed COR and ALD levels and advanced CKMs. A significant additive interaction was observed between COR and ALD on advanced CKMs (RERI = 0.94, 95%CI, 0.35–1.52; AP = 0.41, 95%CI, 0.30–0.52; S = 3.75, 95%CI, 1.84–7.63). Co-exposure analyses showed a 46% higher odds of advanced CKMs in the “High COR, High ALD” group (OR = 1.46, 95%CI, 1.19–1.80, P < 0.001) compared to the “Low COR, Low ALD” group, with consistent trends across most subgroups.

Conclusion

Both COR and ALD show significant associations with advanced CKMs. The joint assessment of COR and ALD improves the identification of high-risk individuals, underscoring the value of adrenal hormone profiling in CKMs risk stratification.

Graphical abstract