{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:55:29Z","timestamp":1784735729204,"version":"3.55.0"},"reference-count":54,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiorenal Med"],"abstract":"<jats:p>Introduction: Sarcopenia has been proved to be associated with cardiovascular diseases (CVD), chronic kidney disease, and metabolic disorders, but the relationship between sarcopenia and all-cause and cardiovascular mortality risk among middle-aged and older adults across stages 0\u20133 of cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. This study aimed to investigate the relationship between sarcopenia and all-cause and cardiovascular mortality risk among middle-aged and older adults across stages 0\u20133 of CKM syndrome based on Nutrition Examination Survey (NHANES) 2011\u20132018 and the China Health and Retirement Longitudinal Study (CHARLS) 2011\u20132020. Methods: Multivariable Cox regression analysis was performed to analyze the association of sarcopenia with all-cause and CVD mortality. Restricted cubic spline (RCS) analysis was conducted to explore the non-linear relationship between body mass index (BMI)-adjusted muscle mass (appendicular skeletal muscle mass divided by BMI, ASMI) and all-cause and CVD mortality, and machine learning (ML) models were developed for mortality risk prediction. The CHARLS database was utilized as validation to enhance the stability of the results. Results: Over an average follow-up of 5.11 years, NHANES recorded 85 all-cause deaths and 12 CVD deaths. After the full adjustment, sarcopenia was significantly associated with all-cause mortality (weighted hazard ratio [HR] = 3.428, 95% confidence interval [CI] 1.484\u20137.915, p = 0.004) and CVD mortality (weighted HR = 1.070, 95% CI 1.009\u20131.570, p = 0.049). RCS analysis revealed a nonlinear negative relationship between ASMI and CVD mortality (p for nonlinear = 0.009). ML models demonstrated better predictive performance, with random forest (area under the curve = 0.766) achieving the highest accuracy. In the CHARLS cohort, sarcopenia significantly increases all-cause mortality (HR = 2.519, 95% CI 1.402\u20134.527, p &lt; 0.001), and subgroup analysis reported consistent results with the main analysis. Conclusion: Sarcopenia was significantly associated with all-cause mortality and with CVD mortality in fully adjusted models, though the latter association was modest, and exhibits good predictive performance for mortality among middle-aged and older individuals within CKM stages 0\u20133.<\/jats:p>","DOI":"10.1159\/000550891","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T17:00:54Z","timestamp":1773939654000},"page":"138-152","source":"Crossref","is-referenced-by-count":1,"title":["The Relationship between Sarcopenia and All-Cause and Cardiovascular Mortality Risk among Middle-Aged and Older Adults across Stages 0\u20133 of Cardiovascular-Kidney-Metabolic Syndrome: Evidence from NHANES and 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