Verhoogd homocysteine voorspelt alle-oorzaak sterfte bij gevorderd CKM-syndroom

BACKGROUND Cardiovascular-kidney-metabolic (CKM) syndrome reflects the overlap of cardiovascular disease, chronic kidney disease, and metabolic disorders. The prognostic relevance of homocysteine (Hcy) in advanced CKM syndrome remains unclear. This study aimed to evaluate the associations of serum Hcy levels with all-cause and cardiovascular mortality in adults with advanced CKM syndrome. MATERIAL AND METHODS This prospective cohort study included 3658 adults with advanced CKM syndrome from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Hcy was analyzed continuously and by tertiles. The primary analyses used survey-weighted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI). Restricted cubic splines assessed potential nonlinear associations. RESULTS During a mean follow-up of 153.4 months, 2008 all-cause deaths and 686 cardiovascular deaths occurred. After full adjustment, each 1-unit increase in Hcy was associated with higher all-cause mortality (HR 1.01, 95% CI 1.00-1.02; P=0.014), and the highest vs lowest Hcy tertile was associated with increased all-cause mortality (HR 1.43, 95% CI 1.19-1.72; P<0.001). For cardiovascular mortality, associations were directionally positive but not statistically significant after full multivariable adjustment for either continuous Hcy (HR 1.01, 95% CI 1.00-1.02; P=0.053) or the highest vs lowest tertile (HR 1.34, 95% CI 0.96-1.86; P=0.082). Restricted cubic spline analysis suggested nonlinear associations. CONCLUSIONS Higher Hcy was independently associated with increased all-cause mortality in adults with advanced CKM syndrome. The association with cardiovascular mortality was directionally positive but did not reach statistical significance after full multivariable adjustment.