Cardiometabolic comorbidity burden and mortality in the United States and China

Area of Science:

• Cardiovascular Medicine and Public Health
• Metabolic Disorders Epidemiology

Background:

• Hypertension, diabetes mellitus, and dyslipidemia are common metabolic disorders.
• These conditions often coexist, forming a cardiometabolic comorbidity burden (CMB).
• Understanding the mortality risk associated with CMB is crucial for public health.

Purpose of the Study:

• To define and quantify cardiometabolic comorbidity burden (CMB) using harmonized data.
• To investigate the association between CMB and all-cause and cardiovascular mortality.
• To assess the predictive value of CMB for mortality outcomes.

Main Methods:

• Utilized harmonized data from four cohorts in the United States and China (38,984 participants).
• Defined CMB as the count of hypertension, diabetes mellitus, and dyslipidemia.
• Employed cohort-specific Cox models and random-effects meta-analysis to assess mortality associations.

Main Results:

• A graded association was observed between CMB count and all-cause mortality.
• Pooled hazard ratios for CMB counts 1, 2, and 3 were 1.10, 1.43, and 2.45, respectively, compared to count 0.
• Hypertension and diabetes mellitus, particularly in combination, were strongly associated with mortality; dyslipidemia alone was not significantly associated.

Conclusions:

• Cardiometabolic comorbidity burden is significantly associated with increased all-cause mortality.
• The combination of hypertension and diabetes mellitus presents the highest mortality risk among dual conditions.
• CMB demonstrates modest predictive improvement for mortality, with higher burdens (counts 2 and 3) accounting for most population-attributable risk.