Cardiovascular
Longitudinal patterns of cardiovascular-kidney-metabolic syndrome in adolescents: Assessments of transition dynamics and clinical determinants Pei-Wen Wu* Pei-Wen Wu Yu-Ting Chin Sharon Tsai Wei-Ting Lin Chien-Hung Lee
Background: Cardiovascular-kidney-metabolic (CKM) syndrome, arising from the intricate interplay of metabolic risk factors, chronic kidney disease, and cardiovascular conditions, is a progressive disorder that can begin in early life. Changes in CKM risk factors during adolescence may impact the development of early stages of CKM syndrome. This follow-up study investigated the conversion of CKM structure among adolescents and evaluated the determinants of CKM transition. Methods: A representative cohort of 1,638 adolescents, recruited from three areas with varying economic levels, was evaluated for CKM syndrome and followed for 2.5 years to determine the transition of CKM stages. Multinomial logistic regression was used to assess the association between changes in cardiovascular risk factors and CKM conversion. Results: At baseline, the prevalence of CKM stages 0, 1, and 2 was 53.8%, 27.7%, and 18.5%, respectively. After 2.5 years, the incidences of stages 1 and 2 were 5.5% and 4.7%. Among adolescents with CKM stage 1 at baseline, 25.3% remitted to stage 0, 49.0% persisted, and 25.7% progressed to stage 2. For those with CKM stage 2, 27.5% remitted to stage 0, 25.5% to stage 1, and 47.1% persisted. Controlling for covariates, a 1-unit increase in body mass index (BMI) and hemoglobin A1c (HbA1c) was associated with 1.45- and 2.43-fold risks of incident CKM stage 1, respectively. Additionally, a 1-unit elevation in systolic blood pressure and triglycerides correlated with 1.08- and 1.03-fold risks of incident CKM stage 2. Reduced BMI and HbA1c levels were linked to remission from stage 1, while decreased fasting blood sugar was associated with remission from stage 2. Conclusion: This study highlights the dynamics of CKM progression and remission in adolescents, emphasizing the roles of BMI and HbA1c in influencing disease stages. Effective management of these factors may enhance remission rates and improve outcomes in CKM.