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CKM syndrome was identified as a medical condition with the presence of metabolic risk factors, cardiovascular disease, and chronic kidney disease, and was classified into five stages (stage 0 to 4). Cox proportional hazards models were applied to explore the association of CKM health with incident dementia and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants in stage 2\u20133 and stage 4 had 1.12-fold (95% CI: 1.02\u20131.23, p\u2009=\u20090.023) and 2.18-fold (95% CI: 1.96\u20132.43, p\u2009&lt;\u20090.001) increased risk of incident all-cause dementia compared with those in stage 0. Similarly, participants in stage 4 also had an increased risk of Alzheimer's disease (HR\u2009=\u20091.51, 95% CI: 1.28\u20131.78, p\u2009&lt;\u20090.001) and vascular dementia (HR\u2009=\u20094.62, 95% CI: 3.54\u20136.03, p\u2009&lt;\u20090.001). Participants in later stages were at higher risk of all-cause mortality. We found an interaction between CKM health and\n                      <jats:italic>APOE4<\/jats:italic>\n                      carrier status (p for interaction &lt;0.001), and the relationship between CKM health and dementia was more pronounced in non-\n                      <jats:italic>APOE4<\/jats:italic>\n                      carriers. Moreover, there were significant additive interactions between\n                      <jats:italic>APOE4<\/jats:italic>\n                      carrier status and CKM health on the risk of dementia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Poor CKM health is independently associated with an increased risk of dementia, regardless of\n                      <jats:italic>APOE4<\/jats:italic>\n                      carrier status, and all-cause mortality. These findings imply that promoting CKM health may help to reduce the risk of subsequent dementia and mortality.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877251324093","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T12:36:11Z","timestamp":1742214971000},"page":"1270-1280","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of cardiovascular-kidney-metabolic health and apolipoprotein E4 genotype with risk of dementia and mortality"],"prefix":"10.1177","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3664-8779","authenticated-orcid":false,"given":"Xinghe","family":"Huang","sequence":"first","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3613-8488","authenticated-orcid":false,"given":"Jie","family":"Liang","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4324-1433","authenticated-orcid":false,"given":"Junyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5780-0996","authenticated-orcid":false,"given":"Jiayi","family":"Fu","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7169-6662","authenticated-orcid":false,"given":"Yige","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7527-1022","authenticated-orcid":false,"given":"Wuxiang","family":"Xie","sequence":"additional","affiliation":[{"name":"Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China"},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2767-2600","authenticated-orcid":false,"given":"Fanfan","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30403-4"},{"key":"e_1_3_5_3_2","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019","volume":"7","author":"GBD 2019 Dementia Forecasting Collaborators","year":"2022","unstructured":"GBD 2019 Dementia Forecasting Collaborators. 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