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Background <p>The cardiovascular–kidney–metabolic (CKM) syndrome framework integrates cardiometabolic risks. However, longitudinal evidence on the association between atherosclerotic cardiovascular disease 10-year risk (ASCVD10&#xa0;year) scores and cardiovascular events across CKM syndrome stages remains limited in large aging populations.</p> Methods <p>We analyzed data from 4,565 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). ASCVD10&#xa0;year scores were calculated using the China-PAR model at baseline (2012) and follow-up (2015), with cumulative risk scores derived accordingly. Participants were stratified into four trajectory clusters via k-means clustering based on ASCVD score dynamics. Logistic regression, restricted cubic spline models, subgroup analysis, and mediation analyses were conducted to assess associations and underlying pathways.</p> Results <p>Higher baseline and cumulative ASCVD10&#xa0;year scores were significantly associated with increased risks of cardiovascular disease (CVD), heart disease, and stroke across CKM stages 0–3 (all <i>P</i> &lt; 0.0001). Compared to the low-risk cluster, the highest-risk cluster exhibited a &gt; 4-fold increased CVD risk (OR = 4.12, 95% CI: 2.81–6.02). Nonlinear associations were observed for CVD and heart disease, with inflection points indicating stronger effects at lower ASCVD ranges. Subgroup analyses revealed stronger associations in individuals ≤ 65 years, females, and those with hypertension or diabetes. Mediation analyses identified HbA1c, fasting glucose, and the TyG index as partial mediators, accounting for 3–6% of the total effect.</p> Conclusions <p>ASCVD10&#xa0;year scores, particularly cumulative exposure, are robust predictors of cardiovascular events across early CKM stages in middle-aged and older adults. These findings support the utility of longitudinal ASCVD10&#xa0;year scores in preventive cardiometabolic strategies.</p>

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Association between 10-year atherosclerotic cardiovascular disease risk score and incident cardiovascular events across stages 0–3 of cardiovascular–kidney–metabolic syndrome: evidence from the China health and retirement longitudinal study (CHARLS)

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  • 发表日期：

    2025年11月14日

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  • Zhitong Li,
  • Wenxia Ren,
  • Xuhui Li,
  • Ruixue Duan,
  • Linlin Gao,
  • Jiaojiao Li,
  • Yajing Bai,
  • Yuanyuan Yan,
  • Angxian Lü,
  • Anqi Zhao,
  • Shiwei Liu

摘要

Background

The cardiovascular–kidney–metabolic (CKM) syndrome framework integrates cardiometabolic risks. However, longitudinal evidence on the association between atherosclerotic cardiovascular disease 10-year risk (ASCVD10 year) scores and cardiovascular events across CKM syndrome stages remains limited in large aging populations.

Methods

We analyzed data from 4,565 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). ASCVD10 year scores were calculated using the China-PAR model at baseline (2012) and follow-up (2015), with cumulative risk scores derived accordingly. Participants were stratified into four trajectory clusters via k-means clustering based on ASCVD score dynamics. Logistic regression, restricted cubic spline models, subgroup analysis, and mediation analyses were conducted to assess associations and underlying pathways.

Results

Higher baseline and cumulative ASCVD10 year scores were significantly associated with increased risks of cardiovascular disease (CVD), heart disease, and stroke across CKM stages 0–3 (all P < 0.0001). Compared to the low-risk cluster, the highest-risk cluster exhibited a > 4-fold increased CVD risk (OR = 4.12, 95% CI: 2.81–6.02). Nonlinear associations were observed for CVD and heart disease, with inflection points indicating stronger effects at lower ASCVD ranges. Subgroup analyses revealed stronger associations in individuals ≤ 65 years, females, and those with hypertension or diabetes. Mediation analyses identified HbA1c, fasting glucose, and the TyG index as partial mediators, accounting for 3–6% of the total effect.

Conclusions

ASCVD10 year scores, particularly cumulative exposure, are robust predictors of cardiovascular events across early CKM stages in middle-aged and older adults. These findings support the utility of longitudinal ASCVD10 year scores in preventive cardiometabolic strategies.