Abstract P393: Trends in Risk Factor Control Among US Adults With Cardio-Kidney-Metabolic Multimorbidity, 1999-2020

Abstract

Background: Risk factor control is foundational to preventing the onset and progression of cardiovascular, kidney, and metabolic (CKM) syndrome. Although risk factor control has been evaluated for these conditions individually, less is known about individuals with CKM syndrome. Objective: To evaluate the control of key risk factors among US adults with CKM syndrome. Methods: Nationally representative, cross-sectional data on US adults from the 1999-2020 NHANES cycles were evaluated. CKM conditions included cardiovascular disease (ASCVD or HF), at least moderate-risk chronic kidney disease, and type 2 diabetes (self-reported or HbA1c ≥6.5%). Among adults with advanced-stage CKM syndrome (≥2 conditions), the proportion with joint control of risk factors was estimated. Risk factor control was defined as: BP <140/90 mmHg, HbA1c <8%, and LDL-C <100 mg/dL. Sensitivity analyses included a stricter definition (BP <130/80, HbA1c <7%, and LDL-C <70) and an expanded set of risk factors (BMI <30 kg/m 2 and current non-smoking status). Results: Between 1999-2014, the proportion of US adults with CKM syndrome with joint control of BP, HbA1c, and LDL-C increased from 10.5% (95% CI: 7.8%, 13.2%) to 32.5% (29.6%, 35.5%), then declined to 28.8% (24.4%, 33.1%; estimated number without joint control = 14.5 million) in 2015-2020, per the main definition ( Figure ). Considering more contemporary thresholds, joint risk factor control was observed in less than 1 in 10 US adults across the study interval. Using the most comprehensive definition (BP <130/80, HbA1c <7%, LDL-C <70, BMI <30, non-current smoking) only 2.2% (1.3%, 3.1%) demonstrated optimal control in 2015-2020. Conclusions: Despite improvement between 1999-2014, comprehensive risk factor control among US adults with CKM syndrome declined in 2015-2020. More than 2 in 3 contemporary US adults with CKM syndrome are estimated to have suboptimal risk factor control, amplifying the need for integrative approaches in this high-risk population.