# Gender-related and Age-related Disparities in Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome Among US Adults From 1999-2020: An Analysis of the NHANES Survey

## TL;DR

This study shows that older women in the US now face similar risks of cardiovascular-kidney-metabolic syndrome as older men, highlighting the need for gender-specific prevention strategies.

## Contribution

The study reveals a shift in gender disparities in CKM syndrome prevalence, particularly in older adults, over the past 20 years.

## Key findings

- Younger women were more often in low-risk CKM stages, but this advantage has declined over time.
- Elderly women now have comparable risks of cardiovascular organ damage as elderly men.
- Preventive measures tailored to women are urgently needed based on these findings.

## Abstract

The cardiovascular-kidney-metabolic (CKM) syndrome is defined as the intricate interplay among metabolic risks, chronic kidney disease (CKD) and the cardiovascular system. The deteriorating CKM syndrome contributes to untimely morbidity and mortality. We aim to characterize gender- and age-related disparities in the prevalence of CKM syndrome over the last 2 decades.

A cross-sectional population-based survey.

A total of 32,848 US adults participating in the NHANES survey from 1999 to 2020.

Gender, age (18-44, 45-64, and ≥65), and period (1999-2002, 2003-3008, 2009-2014, and 2015-2020).

Prevalence of CKM stages.

Sample weights and Taylor series linearization method were applied to estimate prevalence and standard errors representative of the noninstitutionalized US adult population. For trend analysis across cycles, survey-weighted logistic regression was employed.

Young women aged < 45 years were classified more often, but with decreasing prevalence, in stages without CKM defining factors (22.7% of women vs 13.5% of men) and more often in stages with cardiovascular organ damage (13.4% of women vs 6.5% of men). Elderly women were increasingly classified in stages with cardiovascular organ damage over the last 20 years, reaching the same prevalence as men in the most recent period (25.3 % [95% CI, 20.0 %-30.6 %] of women vs 30.5 [95% CI, 25.7-35.3%] of men aged > 65 years).

NHANES data allow for assessing CKM stages with cardiovascular organ damage mainly based on self-reporting during interviews.

We demonstrate an increasing proportion of women in advanced CKM stages over the last 20 years. Whereas the overrepresentation of younger women in the low-risk stages almost disappeared, elderly women in the last period showed almost the same risk of being in stages with cardiovascular organ damage as elderly men. Our analysis highlights an urgent need of preventive measures especially tailored to women.

Cardiovascular-kidney-metabolic (CKM) syndrome describes the combined impact of heart, kidney, and metabolic health on overall well-being. We examined its prevalence among US adult population and explored differences between women and men across different age groups, using data from over 32,000 adults collected from 1999 to 2020. The results showed that younger women under 45 years were previously more likely to be in the low-risk group; however, this advantage has declined over the past 20 years. Among older adults (over 65 years), women had a comparable risk to men for organ damage associated with cardiovascular-kidney-metabolic syndrome. Our study highlights that there is an urgent need for prevention strategies especially tailored to women.