Association of Sarcopenia and Longitudinal Changes in Sarcopenia Status with All-Cause Mortality in Individuals with Cardiovascular-Kidney-metabolic Syndrome

We investigated the associations of sarcopenia, handgrip strength (HGS), appendicular skeletal muscle mass index (ASMI), and longitudinal changes in sarcopenia status with all-cause mortality among middle-aged and older adults aged ≥ 50 years with cardiovascular-kidney-metabolic (CKM) syndrome. This prospective cohort study included 6,601 participants with CKM syndrome from the China Health and Retirement Longitudinal Study (CHARLS), of whom 454 had sarcopenia at baseline. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2025 criteria. Cox proportional hazards models and restricted cubic splines were used to examine the associations of sarcopenia, HGS, and ASMI with all-cause mortality. Joint associations across CKM stages were further evaluated. Longitudinal analyses of changes in sarcopenia status were conducted among 4,842 participants with repeated assessments. During a mean follow-up of 8.75 ± 1.34 years, 251 deaths occurred. Sarcopenia was associated with an increased risk of all-cause mortality (HR, 2.098; 95