Associations of PM 2 .5 and Its Constituents With the Dynamic and Accelerated Progression of Cardiovascular‐Kidney‐Metabolic Syndrome: The Gold‐Health Cohort

ABSTRACT Background The effects of exposure to fine particulate matter (PM 2.5 ) constituents on the dynamic progression of cardiovascular‐kidney‐metabolic (CKM) syndrome remain unclear. Methods Based on the Guangzhou Older Longitudinal Dynamic Health (GOLD‐Health) cohort, we included 41 175 individuals at CKM stage 0–1, 266 016 at stage 2, and 206 692 at stage 3, classified according to American Heart Association guidelines. Individual‐level exposures to PM 2.5 and its five constituents—black carbon (BC), organic matter (OM), sulphate (SO 4 2− ), nitrate (NO 3 − ) and ammonium (NH 4 + )—were estimated at geocoded residential addresses using bilinear interpolation. Multi‐state models and accelerated failure time (AFT) models were applied to evaluate associations with dynamic CKM progression. Results During 1.49 million person‐years of follow‐up, we documented 26 089 transitions from stage 0–1 to stage 2, 125 456 to stage 3, 18 561 to stage 4, and 39 614 deaths. Exposure to PM 2.5 and all five constituents was significantly associated with CKM stage transitions, with effect estimates varying across stages. The transition from stage 3 to stage 4 showed the greatest risk, with a highest hazard ratio of 1.562 (95% CI: 1.548–1.577). AFT models further indicated that higher exposure levels were associated with accelerated CKM progression, with OM exhibiting the strongest effects across most transitions; for example, each standard deviation increase in OM exposure was associated with a 22.1% acceleration in transition time from stage 2 to stage 3. Conclusion Targeted mitigation of PM 2.5 constituents, particularly organic matter, may help slow CKM progression and reduce the associated disease burden.