Chronic diseases are the leading cause of death and disability in the United States. A newly defined, dangerous condition highlights the close relationship among several of these common chronic diseases, which plague millions of Americans.
In an advisory published on Oct. 9, the American Heart Association identified the strong connection between cardiovascular disease, kidney disease, Type 2 diabetes and obesity and, for the first time, is defining the overlap in these diseases as a new medical condition: cardiovascular-kidney-metabolic syndrome, or CKM syndrome.
One in three (33%) adults in the U.S. have three or more risk factors that contribute to heart disease, kidney disease or metabolic disorders, according to the AHA’s 2023 Statistical Update. Type 2 diabetes and obesity, the two main metabolic disorders under the CKM umbrella, are on the rise and affecting more young people, according to the U.S. Centers for Disease Control and Prevention.
What is cardiovascular-kidney-metabolic, or CKM, syndrome?
CKM syndrome refers to the spectrum of cardiovascular, kidney and metabolic diseases, such as Type 2 diabetes and obesity, and how they overlap, potentially increasing a person's risk of dying from heart disease.
“The conditions that make up CKM syndrome are not new. ... We’ve known these increase the risk for heart disease for years,” NBC News medical contributor Dr. Natalie Azar said in a TODAY segment aired Oct. 9. "What's happening is the AHA wants to reset the framework of how people think about heart disease risk, prevention and management."
Ultimately, the goal of defining CKM syndrome is to get earlier diagnosis and treatment for people at high risk of dying from heart disease, NBC News reported. Heart disease is the No. 1 killer of men and women in the U.S., per the CDC.
CKM syndrome can negatively affect almost every major organ in the body, including the heart, brain, kidneys, and liver, per the AHA — but its biggest impact is on the cardiovascular system. CKM syndrome affects the blood vessels, heart muscles and the rate of fatty buildup of in the arteries, the AHA said in its advisory.
An estimated 90% of U.S. adults fall on the CKM spectrum, Dr. Chiadi Ndumele, the lead author of the AHA advisory and the director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University, told NBC News.
The advisory addresses how to identify people at the early stages of CKM syndrome, Ndumele said in a news release. "Screening for kidney and metabolic diseases will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease," said Ndumele.
What are the stages of CKM syndrome?
CKM syndrome can be broken down into stages, which correlate to specific screenings and therapies to detect CKM-related health changes and prevent progression to the next stage, per the AHA.
- Stage 0: A person has no cardiovascular, kidney or metabolic risk factors. The AHA advises to maintain lifestyle habits and get heart-health screenings every three to five years to assess blood pressure, triglycerides, blood sugar and cholesterol.
- Stage 1: A person is overweight and/or has excess abdominal fat, impaired glucose tolerance or pre-diabetes. The AHA advises following a healthy lifestyle with a goal of 5% weight loss, and heart-health screenings every two to three years.
- Stage 2: A person has kidney disease, Type 2 diabetes, high blood pressure, or high triglycerides. The AHA advises treatments to prevent progression to heart disease or kidney failure, including medications to control blood pressure, blood sugar, or cholesterol. Patients may be prescribed as Ozempic or Wegovy for weight loss, says Azar. Yearly heart-health and kidney function screenings are recommended.
- Stage 3: A person has early asymptomatic heart disease with metabolic risk factors or kidney disease, or a high risk of heart disease. The AHA advises increasing or changing medications for diabetes or heart disease, yearly screenings, as well as tests to assess the narrowing of arteries.
- Stage 4: A person has diagnosed, symptomatic heart disease and excess body fat, metabolic risk factors or kidney disease. Stage four is divided into two categories, those with kidney failure and those without it. Patients may have already suffered a heart attack, stroke, or heart failure. The AHA advises treating heart disease with consideration of CKM conditions.
"This is a framework that we can all look and say, 'Where do I fit along here?'" says Azar. "The point is to (prevent progress) or regress, so if you're in stage 3, or 2 or 1, you want to go backwards, not forward," Azar adds.
CKM syndrome and heart disease
In its advisory, the AHA also unveiled a new tool predict a person’s likelihood of having a heart attack, stroke or heart failure in the future.
"The old risk calculator was used to predict 10-year probability of these outcomes in people between 40 and 75," says Azar. The new risk calculator will start for people at age 30 and predict both a 10-year and 30-year probability for having a heart attack, stroke or congestive heart failure, Azar explains.
“The best part about the new calculator is it will incorporate these new kidney numbers, diabetes numbers, and also social determinants of health," says Azar. Social determinants of health are non-medical factors that affect health outcomes, per the CDC, such as income, environment and access to health care or nutritious food.
More research is needed to better understand the pathways leading to heart disease in people with CKM syndrome, why some people advance faster through the stages of CKM and how to use new therapies to improve CKM risk factors and prevent heart disease, the AHA said in a release.