Cardiovasc Revasc Med. 2026 May 7:S1553-8389(26)00195-8. doi: 10.1016/j.carrev.2026.05.001. Online ahead of print.
ABSTRACT
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome is characterized by the interactions among metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). Stage 4 CKM is characterized by clinical CVD. Management of stage 4 CKM involves control of comorbidities, blood pressure, and statin therapy.
OBJECTIVES: This study examines global patterns and demographic disparities in the use of statins and antihypertensives among patients with stage 4 CKM, and evaluates outcomes stratified by age, sex, and race.
METHODS: This is a retrospective cohort of patients >30 of age with stage 4 CKM and low-density lipoprotein ≥100 mg/dL (2010-2019) from the TriNetX Network. Healthcare organizations that did not report medication use were excluded. Stage 4 CKM was defined as dyslipidemia, or hypertension, or diabetes, or CKD, with any form of CVD. Outcomes, including all-cause mortality and major acute cardiovascular events (MACE), were compared across subgroups using Kaplan-Meier survival analysis and Cox regression.
RESULTS: 823,468 patients were included, 60% were taking statins. Females and white patients were less likely to take statins. All-cause mortality was 16% and MACE was 25% in the overall population at 5 years. Males had a higher mortality risk compared to females (HR: 1.09 (1.07-1.10)), and white patients had a lower mortality risk but a higher risk of MACE.
CONCLUSIONS: Although blood pressure control and statins are recommended for patients with stage 4 CKM, only 60% of those patients are taking statins. Females and white patients are less likely to take statins, and males, older patients, and non-white patients have poorer outcomes.
PMID:42106205 | DOI:10.1016/j.carrev.2026.05.001