Associations of Movement and Sleep Behaviors through the Cardiovascular-Kidney-Metabolic Stage Progression (CARDIA CKMoverS)

About This Grant

ABSTRACT Cardiovascular-Kidney-Metabolic (CKM) syndrome is a progressive condition with a four-stage grading approach caused by the interplay between obesity, diabetes, chronic kidney disease, and cardiovascular disease (CVD). There is a high burden of poor CKM health in US adults. The progression from metabolically healthy to advanced CKM stages (subclinical or clinical CVD and kidney failure) takes several decades to develop. As such, few studies are capable of understanding the natural lifelong disease progression of CKM. The Coronary Artery Risk Development in Young Adults (CARDIA) study provides a unique opportunity to study CKM stage progression in a cohort with 40 years of continuous follow-up since early adulthood (18-30 years), including repeated assessments of physical activity and sleep. The Year 40 in-person exam is scheduled for 2026 and 2027 when participants will be 59 to 71 years old. We propose a four-year CARDIA ancillary study, CARDIA Moving through Cardiovascular-Kidney-Metabolic Syndrome (CKMoverS) Study, to obtain 7 days of accelerometry measures to be paired with the existing data collected from early adulthood through the start of older adulthood to capture, for the first time, CKM progression states in an estimated 3,103 Black and White men and women expected to return for the Year 40 exam (11th CARDIA exam). We will add gold standard accelerometry measures to assess movement behaviors (sedentary behavior, light intensity physical activity, and moderate to vigorous intensity physical activity [MVPA]) to the CARDIA Year 40 exam. This will advance knowledge on the benefits of light intensity physical activity which compose a significant portion of the 24-hour day but cannot be accurately measured by self-report. CARDIA CKMoverS is a vital opportunity to significantly enhance the scope of CARDIA by clarifying novel associations and future intervention targets between movement behaviors and CKM disease progression during the critical life transition of midlife into older adulthood. CARDIA CKMoverS will address the limited evidence of risk factors associated with accelerated CKM progression and lifestyle behaviors to target earlier stages of CKM to reduce risk and limit advancement to CVD. To address this goal we will quantify the burden and rate of accelerated CKM progression across 40 years of adulthood, examine the role and critical window(s) of reported MVPA and sedentary behavior with accelerated CKM progression risk, and given recent evidence suggests that the optimal period in life to intervene on health is midlife, we will estimate the 20-year associations of accelerometer-determined sedentary and physical activity (light to vigorous intensity) and sleep movement behaviors across midlife on CKM progression risk. Finally, we will fill knowledge gaps regarding risk factors of CKM by examining if these associations are moderated by several sociodemographic risk factors. CARDIA CKMoverS will address current evidence gaps and provide empirical evidence for the critical widows for lifestyle modifications to intervene within the progression of CKM and attenuate the projected disease burden.