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논문분류	춘계학술대회 초록집
제목	Cardiovascular-Kidney-Metabolic Syndrome (CKMS) and Risk of Incident Atrial Fibrillation in Elderly Adults Aged 75 Years: A Nationwide Cohort Study
저자	Jung Hun Koh
출판정보	2026; 2026(1):
키워드	Cardiovascular-Kidney-Metabolic Syndrome, atrial fibrillation, aged, chronic kidney disease
초록	Objectives: Cardiovascular-kidney-metabolic (CKM) syndrome reflects the multisystem pathophysiology among metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). While atrial fibrillation (AF) is highly prevalent in the elderly, the association between CKM syndrome stages and incident AF in the very old (≥75 years) remains less examined. This study aimed to evaluate the risk of incident AF according to CKMS stages in a nationwide elderly cohort. Methods: We analyzed data from the National Health Insurance Service (NHIS) of South Korea, including 1,161,805 participants aged 75 years or older who underwent health examinations between 2012 and 2015. Participants were categorized into CKMS stages (0 to 4) based on the American Heart Association (AHA) definition. The primary outcome was incident AF. Results: During a mean follow-up of 7.25 years, 124,860 cases of AF occurred. Compared to Stage 0 (N = 34,542), the risk of incident AF increased progressively with higher CKM stages. In the fully adjusted model, the HRs for incident AF were 1.10 for Stage 1, 1.20 for Stage 2, 1.56 for Stage 3, and 1.83 for Stage 4 (all P <0.001). Even within Stage 3, patients with very high-risk CKD or high predicted 10-year CVD risk showed significantly higher AF incidence (18.44 per 1,000 person-years). Conclusion: Higher CKMS stages are significantly and independently associated with an increased risk of incident AF in the elderly population aged 75 and older. These findings suggest that early identification and management of CKMS components are crucial for AF prevention in the very old, where the burden of metabolic and kidney dysfunction is highest.
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