Cardiometabolic multimorbidity (co-existence of ≥1 cardiometabolic diseases) is increasingly common, while its prevalence in the U.S. is unknown. We utilized data from 10 National Health and Nutrition Examination Survey (NHANES) two-year cycles in U.S. adults from 1999 to 2018. We reported the age-standardized prevalence of cardiometabolic multimorbidity in 2017–2018 and analyzed their trends during 1999–2018 with joinpoint regression models. Stratified analyses were performed according to gender, age, and race/ethnicity. In 2017–2018, the prevalence of cardiometabolic multimorbidity was 14.4% in the U.S., and it was higher among male, older, and non-Hispanic Black people. The three most common patterns were hypertension and diabetes (7.5%); hypertension, diabetes, and CHD (2.2%); and hypertension and CHD (1.8%). During 1999–2018, the prevalence of cardiometabolic multimorbidity in U.S. adults increased significantly, with an averaged two-year cycle percentage change (AAPC) of 3.6 (95% CI: 2.1 to 5.3). The increasing trend was significant for both genders, most age groups except for 60–79 years, and non-Hispanic White people. For common patterns, the trend was increasing for hypertension and diabetes and hypertension, diabetes, and CHD, while it was decreasing for hypertension and CHD. Our findings provide evidence that cardiometabolic multimorbidity has risen as an austere issue of public health in the U.S.

Background: Cardiometabolic multimorbidity (CMM) is becoming increasingly common in patients with hypertension, and it is well established that healthy lifestyle plays a key role in the prevention of hypertension. However, the association between combined lifestyle factors and CMM in patients with hypertension is uncertain.Methods: This prospective analysis included the data (obtained from the UK biobank) of participants with hypertension who did not have coronary heart disease (CHD), stroke, or diabetes. The outcome was the occurrence of CMM, defined as ≥ 1 disease of CHD, stroke, and diabetes that occurred in participants with hypertension. Four lifestyle factors (smoking, alcohol consumption, diet, and physical activity) were assessed using a weighted healthy lifestyle score, and participants were divided into four groups: the very unhealthy, unhealthy, healthy, and very healthy groups. The flexible parameter Royston-Parmar proportional hazard model was used to estimate hazard ratios (HRs) between lifestyles and CMM, as well as the difference in CMM-free life expectancy.Results: During a median follow-up of 12.2 years, 9812 (18.4%) of the 53,397 hypertensive patients occurred CMM. Compared with the very unhealthy group, the very healthy group had a 41% reduction in the risk for CMM in hypertensive patients and a 32–50% reduction in the risk for specific cardiometabolic diseases such as CHD, stroke, and diabetes. For each lifestyle factor, non-smoking had the greatest protective effect against CMM (HR: 0.64, 95% confidence interval (CI) 0.60–0.68). A lifestyle combining multiple healthy factors extended CMM-free life expectancy (e.g., six years longer at age 45 years for participants in the very healthy group).Conclusions: Combined healthy lifestyle factors were associated with a lower risk for CMM in hypertensive patients. This suggests that combined healthy lifestyle should be supported to decrease disease burden.

Background: Although the association between beverages and a single cardiometabolic disease has been well studied, their role in disease progression from the single cardiometabolic disease state to cardiometabolic multimorbidity (CMM) state remains unclear. This study examined the associations between three types of beverages: sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and pure fruit/vegetable juices, and the incidence of CMM in patients with a single cardiometabolic disease. Methods: Our analysis included 37,994 participants from the UK Biobank who completed at least one dietary questionnaire and were diagnosed with only one cardiometabolic disease at the time of recruitment. Competing risk models were used to examine the association between the three types of beverages and incidence of CMM. We conducted analysis both in patients with any single cardiometabolic disease and in patients with specific cardiometabolic disease. Results: During a median follow-up of 9.1 years (interquartile range [IQR] 9.0–9.8), a total of 6399 participants developed CMM. The consumption of SSBs and ASBs (>1 serving per day) was associated with a higher risk of CMM (SSBs: hazard ratio [HR] 1.19, 95% confidence interval [95% CI] 1.08–1.31; ASBs: HR 1.15, 95% CI 1.04–1.27). Intake of pure fruit/vegetable juices was inversely associated with the incidence of CMM (0–1 serving per day: HR 0.90, 95% CI 0.85–0.94; >1 serving per day: HR 0.90, 95% CI 0.81–0.99). However, the association of the high-level consumption of pure fruit/vegetable juices (>1 serving per day) was not statistically significant after correcting for multiple testing. In the analysis of patients with specific cardiometabolic diseases, positive associations were observed in patients with hypertension for SSBs consumption, while inverse associations persisted in patients with cardiovascular disease (coronary heart disease or stroke) and in hypertensive patients for pure fruit/vegetable juice consumption. Conclusions: Consuming >1 serving of SSBs and ASBs per day was associated with a higher risk of CMM in patients with a single cardiometabolic disease. In contrast, intake of pure fruit/vegetable juices was inversely associated with the risk of CMM. Our findings highlight the need to limit the use of SSBs and ASBs in patients with a single cardiometabolic disease.

Background and Aims: Earlier studies evaluated the association between systolic blood pressure variability (SBPV) measured during a single period and risk of health outcomes. This study expanded upon existing evidence by examining the association between changes in SBPV over time and clinical outcomes in primary care settings. Methods: Visit-to-visit SBPV was determined as standard deviation of ≥3 systolic blood pressure values measured at 5–10 (Period 1) and 0–5 (Period 2) years before enrolment in the UK Biobank. Cox proportional hazards models were used to evaluate associations of absolute changes in SBPV and SBPV change patterns between these two periods with risk of cardiovascular disease (CVD), coronary heart disease (CHD), stroke, atrial fibrillation and flutter (AF), heart failure (HF), chronic kidney disease (CKD), dementia, and overall mortality. Results: A total of 36 251 participants were included with a median follow-up time of 13.9 years. In the fully adjusted models, an increased SBPV from Period 1 to Period 2 was significantly associated with an increased risk of CVD, CHD, stroke, CKD, and overall mortality (all P for trend < .005), reflecting a 23%–33% increased risk comparing participants with an increase in SBPV above Tertile 3 with those below Tertile 1. An increase in SBPV from Period 1 to Period 2 appeared to be associated with an increased risk of AF, HF, and dementia; however, the associations did not reach statistical significance at P < .005. The restricted cubic spline analysis did not reveal non-linear associations, as all P-values for non-linearity were >.05. Regarding SBPV change patterns, compared with the participants with consistently low SBPV, participants with a consistently high SBPV during the two periods had an increased risk of CVD, CHD, stroke, AF, HF, CKD, and overall mortality, with a risk evaluation of 28%–46%. The observed associations remained largely unchanged across subgroup and sensitivity analyses. Conclusions: An increase in SBPV over time was associated with an elevated risk of CVD, CKD, and overall mortality. These findings provide compelling evidence to inform the importance for the management of SBPV in clinical practice.

Although frailty was associated with cardiometabolic diseases (CMDs, including coronary heart disease, stroke, and diabetes here), there was no systematic analyses estimating its role in incidence, progression, and prognosis of cardiometabolic multimorbidity (CMM). We included 351,205 participants without CMDs at baseline in UK Biobank. Occurrences of first CMD, CMM, and death were recorded. We used multi-state models to assess transition-specific role of baseline frailty measured by frailty phenotype and frailty index in CMM progression trajectory from no disease to single CMD, CMM, and death. Association between changes in frailty and outcomes was investigated among 17,264 participants. Among 351,205 participants (44.0% male, mean age 56.55 years), 8,190 (2.3%) had frail phenotype, and 13,615 (3.9%) were moderate/severe frail according to frailty index. During median follow-up of 13.11 years, 41,558 participants experienced ≥1 CMD, 4,952 had CMM, and 20,670 died. In multi-state models, frail phenotype-related hazard ratios were 1.94 and 2.69 for transitions from no CMD to single disease and death, 1.63 and 1.67 for transitions from single CMD to CMM and death, and 1.57 for transitions from CMM to death (all P <0.001). Consistent results were observed for frailty index. Improvement of frailty reduced the risk of CMD progression and death. Frailty is an independent risk factor for all transitions of CMM progression trajectory. Frailty-targeted management is a potential strategy for primary and secondary prevention of CMM beyond chronological age.

Depression and sleep duration were only mutually adjusted in a few studies, and it is unknown whether these two factors are independent or overlapping risk factors for cardiometabolic diseases (CMDs) and mortality. This study aimed to evaluate the individual and joint associations of depression and sleep duration with CMDs and mortality. A total of 261,297 participants who were free of CMD at baseline were included. Sleep duration was divided into three groups (short: 9 h/day; ages 65+ years: >8 h/day). The main outcomes were hypertension, stroke, CHD, DM, all-cause mortality, and cardiovascular mortality. Among the 261,297 participants, depression and short or long sleep duration were independently associated with increased risk of CMDs and mortality (hazard ratio [HR], 1.10-1.38) when they were mutually adjusted, except for the association between short sleep duration and stroke (HR, 1.03; 95% confidence interval [CI], 0.97-1.10). We documented significant additive interactions between depression and short sleep duration in relation to all-cause mortality (relative excess risk due to interaction [RERI], 0.19; 95% CI, 0.02-0.37) and CHD (RERI, 0.30; 95% CI, 0.11-0.48). In this study, depression and short or long sleep duration were independently associated with an increased risk of CMDs and mortality. We also observed significant additive interactions between depression and short sleep duration in relation to all-cause mortality and CHD.