{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T16:28:33Z","timestamp":1794068913002,"version":"4.8.0"},"reference-count":73,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec id=\"ab-hoi230046-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Individually, cardiac, renal, and metabolic (CRM) conditions are common and leading causes of death, disability, and health care\u2013associated costs. However, the frequency with which CRM conditions coexist has not been comprehensively characterized to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi230046-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the prevalence and overlap of CRM conditions among US adults currently and over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi230046-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>To establish prevalence of CRM conditions, nationally representative, serial cross-sectional data included in the January 2015 through March 2020 National Health and Nutrition Examination Survey (NHANES) were evaluated in this cohort study. To assess temporal trends in CRM overlap, NHANES data between 1999-2002 and 2015-2020 were compared. Data on 11\u202f607 nonpregnant US adults (\u226520 years) were included. Data analysis occurred between November 10, 2020, and November 23, 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi230046-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Proportion of participants with CRM conditions, overall and stratified by age, defined as cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), or all 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi230046-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2015 through March 2020, of 11\u202f607 US adults included in the analysis (mean [SE] age, 48.5 [0.4] years; 51.0% women), 26.3% had at least 1 CRM condition, 8.0% had at least 2 CRM conditions, and 1.5% had 3 CRM conditions. Overall, CKD plus T2D was the most common CRM dyad (3.2%), followed by CVD plus T2D (1.7%) and CVD plus CKD (1.6%). Participants with higher CRM comorbidity burden were more likely to be older and male. Among participants aged 65 years or older, 33.6% had 1 CRM condition, 17.1% had 2 CRM conditions, and 5.0% had 3 CRM conditions. Within this subset, CKD plus T2D (7.3%) was most common, followed by CVD plus CKD (6.0%) and CVD plus T2D (3.8%). The CRM comorbidity burden was disproportionately high among participants reporting non-Hispanic Black race or ethnicity, unemployment, low socioeconomic status, and no high school degree. Among participants with 3 CRM conditions, nearly one-third (30.5%) did not report statin use, and only 4.8% and 3.0% used glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, respectively. Between 1999 and 2020, the proportion of US adults with multiple CRM conditions increased significantly (from 5.3% to 8.0%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend), as did the proportion having all 3 CRM conditions (0.7% to 1.5%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi230046-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cohort study found that CRM multimorbidity is increasingly common and undertreated among US adults, highlighting the importance of collaborative and comprehensive management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2023.3241","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T11:33:44Z","timestamp":1695814424000},"page":"1050","source":"Crossref","is-referenced-by-count":319,"title":["Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020"],"prefix":"10.1001","volume":"8","author":[{"given":"John W.","family":"Ostrominski","sequence":"first","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne V.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute and University of Missouri\u2013Kansas City, Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"Department of Medicine, University of Mississippi, Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, Los Angeles Medical Center, David Geffen School of Medicine, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie S.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swetha R.","family":"Palli","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie M. 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