Heart Failure

Cardiovascular-Kidney-Metabolic Syndrome Stages, Echocardiographic Characteristics, and Heart Failure Risk: ARIC

• Authors: ARIC investigators
• Journal / date: Circulation, 2026
• DOI / URL: 10.1161/CIRCULATIONAHA.125.077894 | PMID 41919388
• Source basis: Abstract only
• Study type: Community cohort, prospective follow-up
• Population: ARIC visit 5 (2011-2013), n=5646, age 66-90, with echo
• Exposure: AHA CKM syndrome staging framework (stages 0-4b)
• Primary endpoint & result: Incident HF over median 9 years (656 events among 4827 HF-free at baseline)
• Stage 2: 2.9 events / 1000 person-years (referent)
• Stage 3: 15.1/1000 PY — adjusted HR 3.6 (95% CI 2.1-6.0)
• Stage 4: 37.4/1000 PY — adjusted HR 8.3 (95% CI 4.9-14.2), p<0.001
• Key findings: Higher CKM stage incrementally associated with adverse LV remodeling, worse systolic and diastolic function, and greater progression of remodeling by visit 7.
• Why it matters (clinical takeaway):
• Validates the AHA CKM staging framework as a real-world prognostic tool for incident HF in older adults — useful for risk-stratifying who needs intensified preventive GDMT (SGLT2i, GLP-1, finerenone).
• Stage 3+ patients are not "low risk" — 4-8× incident HF risk warrants active monitoring, not just lifestyle counseling.
• Most community-dwelling older adults fall into stages 3-4 (88%), so CKM staging is high-yield in everyday outpatient cardiology.
• Caveats / limitations: Observational; CKM stage is a composite construct that may move with comorbidity progression. Not yet a randomized intervention trial.
• Referenced trials pulled forward: None pulled this pass.