Association between the oxidative balance score and all-cause and cardiovascular mortality in patients with cardiovascular-kidney-metabolic syndrome - a retrospective cohort study from the NHANES

Q: What is the oxidative balance score (OBS) used for in this study?

OBS is used to quantify oxidative-stress-related exposures. The study evaluates whether OBS levels are associated with mortality outcomes in CKM patients.

Q: How was the association between OBS and mortality analyzed?

Kaplan-Meier survival analysis and multivariable Cox regression were used to test relationships between OBS and all-cause or cardiovascular mortality, alongside restricted cubic spline modeling and subgroup analyses.

Q: What did the study find about higher OBS and mortality risk?

Individuals in the highest OBS quartile had lower all-cause and cardiovascular mortality than those in the lowest quartile. The results also show a graded inverse (dose-dependent protective) relationship between OBS and mortality risk.

Sep 30, 2026

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Background: The study examines how the oxidative balance score (OBS), a metric reflecting oxidative-stress-related exposures, relates to all-cause and cardiovascular mortality in patients with cardiovascular-kidney-metabolic (CKM) syndrome. Methods: Using 15,357 CKM patients from NHANES (2003–2018), Kaplan-Meier survival, multivariable Cox regression, restricted cubic splines, and subgroup analyses assess mortality risk across OBS levels. Results: Higher OBS shows lower mortality, including graded inverse associations. Conclusion: Elevated OBS is linked to reduced all-cause and cardiovascular mortality in CKM patients.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

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Abstract

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Results

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Introduction

Cheng et al. BMC Cardiovascular Disorders (2026) 26:12 BMC Cardiovascular Disorders [https://doi.org/10.1186/s12872-025-05362-8](https://doi.org/10.1186/s12872-025-05362-8) RESEARCH Open Access Association between the oxidative balance score and all-cause and cardiovascular mortality in patients with cardiovascularkidney-metabolic syndrome——a retrospective cohort study from the NHANES Kun Cheng 1, Kun-xia Lin2, Xiao-fen Zhou 1 and Han Chen 1,3* Abstract Background The American Heart Association recently introduced the concept of Cardiovascular-Kidney-Metabolic (CKM) syndrome, underscoring the intricate interplay between metabolic, renal, and cardiovascular diseases. The oxidative balance score (OBS) serves as a comprehensive metric to quantify oxidative stress-related exposures. This study investigates the association between OBS and both all-cause and cardiovascular mortality in these individuals. Methods The study cohort analyzed 15,357 CKM patients from the 2003 to 2018 National Health and Nutrition Examination Survey database. Kaplan-Meier survival analysis, multivariable Cox regression models, restricted cubic splines, and subgroup analyses were employed to evaluate the relationship between OBS and mortality risk. Results There were 1,759 all-cause deaths and 459 cardiovascular deaths. Kaplan-Meier analysis revealed that individuals in the highest quartile of OBS (Q4) had the lowest all-cause and cardiovascular mortality rates, whereas the lowest quartile (Q1) exhibited the highest mortality rates (p < 0. 001) . In fully adjusted models, multivariable Cox regression showed that each one-unit increase in OBS was associated with a 1. 1% reduction in the risk of all-cause mortality and a 1. 6% reduction in cardiovascular mortality (HR 0 . 989, 95% CI 0.982–0. 996, p = 0 . 003, HR 0 . 984, 95% CI 0.970–0. 998, p = 0 . 026, respectively) . Compared to Q1, individuals in Q4 had significantly lower risks of both allcause mortality (HR 0 . 723, 95% CI 0 .607–0. 861, p < 0. 001) and cardiovascular mortality (HR 0 . 642, 95% CI 0.439–0. 938, p = 0 . 022) . Subgroup analyses indicated that the association between OBS and reduced mortality risk was particularly pronounced among individuals with higher educational attainment, non-chronic kidney disease, high poverty income ratio individuals and more advanced stages of CKM syndrome. In addition, restricted cubic spline modelling identified a graded inverse association between oxidative balance scores (OBS) and mortality risk. This suggests a dose-dependent protective effect of higher OBS, consistently observed across diverse demographic strata and clinical severity levels. *Correspondence: Han Chen[hanchen.cn@icloud.com](hanchen.cn@icloud.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Cheng et al. BMC Cardiovascular Disorders (2026) 26:12 Page 2 of 13 Conclusion Higher

FAQs

What is the oxidative balance score (OBS) used for in this study?

OBS is used to quantify oxidative-stress-related exposures. The study evaluates whether OBS levels are associated with mortality outcomes in CKM patients.

How was the association between OBS and mortality analyzed?

Kaplan-Meier survival analysis and multivariable Cox regression were used to test relationships between OBS and all-cause or cardiovascular mortality, alongside restricted cubic spline modeling and subgroup analyses.

What did the study find about higher OBS and mortality risk?

Individuals in the highest OBS quartile had lower all-cause and cardiovascular mortality than those in the lowest quartile. The results also show a graded inverse (dose-dependent protective) relationship between OBS and mortality risk.

Sep 30, 2026

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