European Primary Care Cardiovascular Society

High and increasing prevalence of cardio-renal-metabolic multimorbidity

Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020

Literature - Ostrominski JW, Arnold SV, Butler JV, et al. - JAMA Cardiol. 2023 Sep 27:e233241 [Online ahead of print]. doi: 10.1001/jamacardio.2023.3241

Introduction and methods


Cardio-renal-metabolic (CRM) conditions are leading causes of morbidity and mortality in the US [1]. As the functions of the CRM systems are highly interconnected [2], individual CRM intersections are becoming more relevant, both clinically and therapeutically [3]. While estimated prevalences of individual CRM conditions in the US have been established (ranging from 9% to 15%) [4-6], the frequency with which CRM conditions coexist has not been systematically assessed.

Aim of the study

The authors examined the current and evolving prevalence and overlap of CRM conditions among US adults.


In this observational cohort study, nationally representative data of 11,607 nonpregnant, US adults (aged ≥20 years) from the National Health and Nutrition Examination Survey (NHANES), a serial cross-sectional survey in the US, were evaluated. To evaluate the contemporary prevalence of CRM conditions, the authors used NHANES data from January 2015 through March 2020, whereas all survey cycles from January 1999 through March 2020 were used to assess trends in the prevalence of CRM conditions over time. To examine temporal trends in CRM overlap, NHANES data for 1999–2002 and 2015–2020 were compared.

CRM conditions were: (1) CVD, defined as ASCVD, HF, or both; (2) renal impairment (CKD), defined according to eGFR and albuminuria; and (3) metabolic disease, defined as the presence of T2D. Prevalences of key CRM risk factors and components of metabolic syndrome, including hypertension, prediabetes, obesity, and hypercholesterolemia, were also examined.

Main results

Prevalence and overlap of CRM conditions

Temporal trends in prevalence and overlap of CRM conditions

Age-stratified analyses

Self-reported prescription medication use by CRM status

Prevalence of key CRM risk factors


This observational population-based cohort study showed that CRM conditions and their overlap were increasingly common among US adults over the last 2 decades. In recent years, more than 25% had 1 CRM condition and nearly 10% had ≥2 CRM conditions. CRM comorbidity burden was especially high in participants who were older, were male, reported non-Hispanic Black race or ethnicity, or who had adverse socioeconomic characteristics.

In addition, key CRM risk factors were prevalent among both participants with and without established CRM conditions. Moreover, across the CRM spectrum, major treatment gaps were observed. “These findings highlight the importance of collaborative and comprehensive management strategies for patients with or at risk for CRM conditions,” according to the authors.


Show references

Find this article online at JAMA Cardiol.

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