Abstract
BACKGROUND: Metabolic syndrome (MetS) is an important criterion for clinicians in assessing cardio-kidney-metabolic diseases, yet the association between longitudinal evolution of MetS and cardio-kidney-metabolic disease multimorbidity remains unclear. OBJECTIVES: The purpose of this study was to investigate the extent of increased multimorbidity risk in individuals recovered from MetS and investigate the mediation of Life's Essential 8 (LE8) score on MetS transition patterns and risk of multimorbidity. METHODS: A cohort study using data from the Kailuan study (2006-2010) was conducted. Cox regression models were used to assess the association of MetS evolution with multimorbidity and its components. Survival mediation analysis was used to calculate the mediation proportion. RESULTS: A total of 36,201 participants were included. During a median follow-up of 12.02 years, 930 participants developed a multimorbidity. Not only the persistent metabolic disorder group (HR: 2.95 [95% CI: 2.41-3.60]) and the MetS progression group (HR: 1.70 [95% CI: 1.39-2.06]) but also the MetS recovery group (HR: 1.87 [95% CI: 1.48-2.36]) were associated with an elevated risk compared with the sustained metabolic health group. LE8 score mediated the association between MetS progress, MetS recover, and persistent MetS and incident cardio-kidney-metabolic multimorbidity, accounting for 24.1% (95% CI: 11.4-44.0), 25.7% (95% CI: 16.4-37.7), and 19.5% (95% CI: 13.7-26.9) of the proportion mediated, respectively. CONCLUSIONS: Both current MetS and a history of metabolic disorder, even in the absence of current MetS, may increase the risk of multimorbidity. Prevention targeting the LE8 may help reduce the risk and provide new perspectives for early intervention.