Cardiovascular-Kidney-Metabolic Syndrome Is Linked to Heart Disease

The American Heart Association presidential advisory has defined cardiovascular-kidney-metabolic (CKM) syndrome as a health condition that raises the risk of cardiovascular disease.

On October 9, the American Heart Association (AHA) released a presidential advisory that marks a significant shift in the clinical approach to heart health. The advisory, published in the AHA journal Circulation, defines cardiovascular-kidney-metabolic (CKM) syndrome as a new condition linked to heart disease risks.

CKM syndrome represents the overlap of cardiovascular disease with kidney disease, type 2 diabetes, and obesity. The AHA officially acknowledges this overlap for the first time, suggesting that individuals with or at risk for cardiovascular disease may also be experiencing CKM syndrome.

According to the AHA's 2023 Statistical Update, one in three United States adults possesses three or more risk factors contributing to cardiovascular disease, metabolic disorders, and kidney disease.

CKM syndrome affects nearly every major organ in the body, with significant impacts on the cardiovascular system. This includes disruptions to blood vessels, heart muscle function, and the rate of fatty buildup in arteries.

According to the advisory, this syndrome results from the high prevalence of obesity and type 2 diabetes in adults and young people.

"The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome," said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, a writing committee chair, associate professor of medicine, and director of obesity and cardiometabolic research at Johns Hopkins University in Baltimore.

Ndumele says screening for CKM syndrome will help healthcare providers start therapies earlier, which may be a better strategy to prevent and manage heart disease.

What are the stages of CKM syndrome?

• Stage 0: Individuals with no CKM risk factors are encouraged to maintain ideal health by following the American Heart Association's Life's Essential 8 recommendations. These recommendations include healthy eating, regular physical activity, quality sleep, nicotine avoidance, and maintaining optimal weight, blood pressure, blood sugar, and cholesterol levels. People in this stage should also receive regular health screenings every three to five years.
• Stage 1: This stage involves individuals with a higher body mass index (BMI), an unhealthy distribution of body fat, or prediabetes. The advisory emphasizes support for healthy lifestyle changes, including diet and exercise, to achieve at least a 5% weight loss. Screening recommendations include regular cholesterol, blood pressure, triglycerides, and blood sugar screenings.
• Stage 2: Those in stage 2 exhibit metabolic risk factors and kidney disease, which elevates the risk for worsening kidney and heart issues. The primary goal at this stage is to address these risk factors to prevent progression to cardiovascular disease and kidney failure, potentially involving medication to control blood pressure, blood sugar, and cholesterol. These might include FDA-approved glucagon-like peptide 1 (GLP-1) receptor agonists such as Ozempic or Wegovy.
• Stage 3: Individuals with early cardiovascular disease, even without symptoms, are classified in this stage if they have metabolic risk factors or kidney disease. The focus is to intensify efforts to prevent symptomatic cardiovascular disease and kidney failure, which may involve medication adjustments and increased emphasis on lifestyle changes.
• Stage 4: This advanced stage of CKM syndrome is divided into two subcategories — 4a for individuals without kidney failure and 4b for people with kidney failure. Folks in stage 4 may have already experienced a heart attack or stroke or may have heart failure. Care at this stage is individualized and considers the specific conditions associated with CKM syndrome.

Regression of CKM can also occur, meaning a person can improve their risk level with weight loss and lifestyle changes. The advisory says people in stages 1, 2, and 3 may have the best opportunity to experience regression.

In addition to these stage-based guidelines, the advisory calls for significant updates to the Pooled Cohort Equation — the current risk calculator for atherosclerotic cardiovascular disease. This tool estimates heart attack or stroke risks in the next 10 years for people ages 40 to 75.

Proposed changes to the Equation include adding measures of kidney function, more precise monitoring of type 2 diabetes control, and consideration of social determinants of health.

In addition, the update would expand to younger people and include a more comprehensive and accurate risk assessment for cardiovascular disease, providing both 10- and 30-year risk estimates.

Ndumele said, "Key partnerships among stakeholders are needed to improve access to therapies, to support new care models, and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health."