90% of U.S. Adults Have This Syndrome That Leads to Heart Disease—and Have No Clue
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Cardiovascular-kidney-metabolic (CKM) syndrome may affect 90% of U.S. adults, new research finds.
CKM is a cluster of conditions that may lead to heart disease and includes: insulin resistance, obesity, hypertension, atherogenic dyslipidemia (a lipid abnormality characterized by high triglycerides and low HDL cholesterol), and chronic kidney disease.
Cardiologists explain how to identify the signs and prevent it from progressing into full-blown heart disease.
A 2023 survey from the American Heart Association (AHA) found that more than half of U.S. adults were unaware that heart disease is the leading cause of death in the country (and has been for 100 years). Now, a new study identifies a condition that may lead to heart disease, cardiovascular-kidney-metabolic (CKM) syndrome. And though people may not even know they have it, the study found that CKM affects up to 90% of U.S. adults.
In 2023, the AHA identified strong connections among heart disease, kidney disease, type 2 diabetes, and obesity, and defined cardiovascular-kidney-metabolic (CKM) syndrome for the first time. Now, new research published in JAMA Network found that 90% of the population had at least stage 1. Researchers from Harvard Medical School used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020 for the study, which involved interviews, physical exams, and lab work in over 10,000 U.S. adults.
Meet the Experts: Cheng-Han Chen, M.D., board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center; Adedapo Iluyomade, M.D., preventative cardiologist with Baptist Health Miami Cardiac & Vascular Institute.
So, what is CKM syndrome and how do you know if you have it, or are at risk for developing it? Ahead, cardiologists explain what you need to know about this complex set of conditions and how to lower your risk of heart disease.
What is CKM syndrome?
Cardiovascular-kidney-metabolic (CKM) syndrome is a cluster of interrelated conditions including insulin resistance, obesity, hypertension, atherogenic dyslipidemia (a lipid abnormality characterized by high triglycerides and low HDL cholesterol), and chronic kidney disease, says Adedapo Iluyomade, M.D., preventative cardiologist with Baptist Health Miami Cardiac & Vascular Institute. “These conditions tend to occur together and significantly increase the risk of developing cardiovascular disease, type 2 diabetes, and kidney failure,” he explains.
Below, Dr. Iluyomade provides a brief overview of the four stages of CKM syndrome:
Stage 0
At this preliminary stage, the AHA suggests screening adults in stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol, and blood sugar.
Stage 1
Insulin resistance develops. Blood sugar may be slightly elevated. Blood pressure, lipids, and kidney function are still normal.
At stage 1, the AHA suggests maintaining healthy lifestyle changes and a goal of at least 5% weight loss (in those with medical indications for it), with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol, and blood sugar.
Stage 2
Prediabetes or type 2 diabetes develops. Hypertension and atherogenic dyslipidemia (high triglycerides, low HDL) are often present. Early signs of kidney dysfunction may emerge.
At stage 2, the goal of care is to address risk factors to prevent progression to heart disease and kidney failure, according to the AHA. Treatment may include medications to control blood pressure, blood sugar, and cholesterol. In those with chronic kidney disease and in some people with type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. Glucagon-like peptide 1 (GLP-1) receptor agonists (medications like Ozempic) may be considered in people with type 2 diabetes to help reduce high glucose, facilitate weight loss, and reduce risk for heart disease.
Screening suggestions for stage 2 CKM syndrome align with AHA guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar, and kidney function. For those with an increased risk of kidney failure based on kidney function assessments, more frequent kidney screening may be recommended.
Stage 3
Sustained high blood sugars and hypertension lead to damage of the heart, blood vessels, eyes, nerves, and kidneys. Plaque buildup in arteries and chronic kidney disease progress.
At stage 3, the goal of care is to intensify efforts to prevent people who are at high risk of progressing to heart disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The AHA recommends coronary artery calcium (CAC) screening in some adults to assess the narrowing of the arteries when treatment decisions are unclear.
Stage 4
Cardiovascular events like heart attack and stroke occur. Kidney disease reaches end-stage, requiring dialysis or transplant. Heart failure develops.
Stage 4 CKM syndrome is divided into two subcategories: those with kidney failure and those without. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for heart disease with consideration for CKM syndrome conditions.
The vast majority of the population is characterized as either stage 1 (overweight/obese), or stage 2 (having at least one more risk factor such as hypertension, some types of diabetes, or hyperlipidemia), says Cheng-Han Chen, M.D., board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center. While there are genetic components to many of these conditions, there are many other reasons for the high prevalence of these risk factors in the U.S., says Dr. Chen, “including unhealthy eating, lack of physical exercise, and other unhealthy habits such as smoking and excess drinking.”
However, despite its prevalence, “CKM syndrome often goes undiagnosed because its components (diabetes, hypertension, dyslipidemia, kidney disease) are evaluated and treated separately rather than as an integrated syndrome,” explains Dr. Iluyomade. Many physicians are not trained to recognize CKM syndrome as one condition that requires the management of a broad range of risk factors, he adds.
Symptoms of CKM syndrome
Signs of CKM syndrome vary based on which component of the syndrome is predominant, says Dr. Iluyomade, but symptoms may include the following issues:
Cardiovascular: Chest pain, shortness of breath, palpitations
Kidney-related: Swelling in legs and ankles, changes in urine output, fatigue
Metabolic: Unexplained weight changes, increased thirst and urination, fatigue
Treatment for CKM syndrome
Because CKM syndrome is not a single condition with one treatment option, it’s important to establish an extensive treatment strategy that includes specialists like cardiologists, nephrologists, endocrinologists, and general practitioners, Dr. Iluyomade explains.
While there isn’t a one-stop solution for CKM syndrome, there are medical interventions and lifestyle changes you can try to stop it from progressing (as outlined above in each stage).
CKM syndrome prevention
So, how can you lower your risk for heart disease and stop CKM syndrome from progressing? Dr. Iluyomade explains that “preventing and managing CKM syndrome involves several lifestyle and medical strategies.” Here are some habits he says you should consider following:
Healthy diet: Focus on a heart-healthy diet like the Mediterranean or DASH diet.
Regular exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity per week.
Weight management: Achieve and maintain a healthy weight to reduce stress on the heart and kidneys and improve metabolic function.
Blood pressure and cholesterol control: Regular monitoring and medication as needed to manage hypertension and lipid levels.
Blood sugar management: For those with types of diabetes, staying in goal blood glucose range is crucial.
Avoiding tobacco and limiting alcohol: Stopping smoking and moderation in alcohol consumption are vital.
The bottom line
This study compiled data on the prevalence of CKM syndrome over time, and found that about 90% of the population was at at least stage 1. The data underscores how prevalent cardiovascular risk factors are in our society, says Dr. Chen. “While the majority of the population was in the early stages (stage one or two, indicating at least overweight/obesity, or the presence of another risk factor like diabetes or hypertension), it is essential that these risk factors be managed properly so that people do not progress to clinical cardiovascular disease,” he explains.
The new research also noted that the risks are greatest among older adults, men, and especially Black individuals—which highlights the need to address health inequities to better serve this high-risk population, says Dr. Chen.
Understanding the two-way interactions within CKM syndrome is key to its early detection and proper management, says Dr. Iluyomade. “For instance, inadequate control of blood sugar levels may lead to diminished kidney function, which could in turn heighten the risk of cardiovascular disease,” he explains.
Because there is no one solution to CKM syndrome, it’s important to establish an extensive treatment strategy that includes a team of specialists Dr. Iluyomade says. “Improving patient awareness about the risk factors and signs of this syndrome, coupled with consistent screenings for at-risk individuals, can significantly improve both health outcomes and the quality of life for those affected,” he notes.
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