The proportion of Hong Kong’s population with cardiovascular-kidney-metabolic (CKM) syndrome has increased from 87.8 percent 20 years ago to 90.8 percent in 2024, an ongoing population-based, cross-sectional study of cardiovascular (CV) risk factors and disease prevalence in Hong Kong Chinese (N-CRISPS) has found.

“Despite socio-economic changes with improvements in education attainment and health literacy over the years, a large proportion of the population in Hong Kong still has excess or dysfunctional adiposity ? overweight/obesity, with or without other metabolic risk factors [hypertriglyceridaemia, hypertension, diabetes], chronic kidney disease [CKD], atherosclerotic cardiovascular disease [ASCVD] or other cardiovascular disease [CVD] [CKM syndrome stage 1],” reported Professor Paul Lee of the Department of Medicine, University of Hong Kong, an investigator of the N-CRISPS study.   

CKM syndrome is a progressive, systemic disorder characterized by pathophysiological interactions among metabolic risk factors, CKD and the CV system, leading to multiorgan dysfunction and a high rate of adverse CV outcomes. The American Heart Association has classified CKM syndrome into five progressive stages, from stage 0 (metabolically healthy, no CKM risk factors) to stage 4 (clinical CVD with/without kidney failure). [Circulation 2023;148:1606-1635]

“Due to the prognostic impact of CKM syndrome, and in view of major changes in diet, lifestyle, level of health literacy, and the overall standard of medical care over the past three decades, investigators of the original HK Cardiovascular Risk Factor Prevalence Study [CRISPS] felt that it is time to determine the current risk factor profile. Hence, N-CRISPS was initiated in December 2019,” said Lee. To date, 3,243 Hong Kong Chinese individuals aged 25?74 years have been recruited for N-CRISPS from the community.

CRISPS was among the noninterventional prospective studies on CV risk conducted in China with the longest follow-up (22 years [1995?2016]; n=2,895; male, 49 percent). It was the first population-based, age-stratified study of CV risk factors, including type 2 diabetes, with comprehensive CV risk assessment in Hong Kong Chinese. “The study, conducted in a unique, genetically homogeneous and urbanized Chinese population, is very valuable,” noted Lee.

CRISPS found that higher CKM syndrome stages were associated with higher risks of all-cause and CV mortality over 20 years (sex and age-adjusted hazard ratio [95 percent confidence interval] for all-cause mortality vs stage 0: stage 1, 1.1 [0.5?2.7], p=0.766; stage 2, 1.7 [0.8?3.3], p=0.146; stage 3, 3.8 [1.8?7.9], p<0.001; stage 4, 3.7 [1.6?8.3], p=0.002; p<0.001 for trend). [Li L, et at, unpublished data]

“Compared with CRISPS, N-SCRISPS cohort had a higher education level, a higher proportion of the population in the 65?74 years age group [10.3 vs 5.7 percent], more never-married individuals [30 vs 13 percent], more engagement in sedentary work [64 vs 30 percent], fewer current smokers [10 vs 19 percent], and more drinkers [men, 75 vs 56 percent; women 57 vs 20 percent],” reported Lee. “Notably, there was a higher proportion of undiagnosed diabetes in the younger age groups. Hypertension [CKM syndrome stage ≥2] became more prevalent [30 vs 18 percent], especially among the younger age groups.” 

“Excess adiposity, especially visceral fat, is a public health concern, with men being affected more than women. Early detection of diabetes and hypertension [ie, CKM syndrome stage ≥2] is important, especially in the younger population. Maintaining individuals at early CKM syndrome stages may help lower mortality risks,” Lee concluded.