What is CKM Syndrome? Report Finds Most Americans Meet Criteria For Early Stages

Fact checked by Nick BlackmerFact checked by Nick Blackmer

  • A study found about 90% of U.S. adults met the criteria for stage one or higher of cardiovascular-kidney-metabolic (CKM) syndrome.

  • CKM syndrome is broken into different stages; the overwhelming majority of study participants had either stage one or two of the condition.

  • Experts urge people to talk to their doctors about CKM syndrome.



Almost 90% of Americans meet the criteria for cardiovascular-kidney-metabolic (CKM) syndrome, according to a new report.

The JAMA study, published on May 8, looked at a population of over 10,000 adults between 2011 and 2020, and found that nearly nine in 10 people had at least stage one of CKM syndrome. About 15% had advanced CKM syndrome.

The condition—just classified by the American Heart Association in October—is defined as the intersection of heart disease, kidney disease, and the metabolic conditions type 2 diabetes and obesity.

Though these four conditions are often diagnosed separately, having one can put a person at a higher risk for the other three. For example, people with heart disease have an increased risk of developing type 2 diabetes, obesity, and kidney disease.

CKM syndrome is broken into different stages, and earlier stages are generally defined by risk factors for the four conditions, including prediabetes or excess weight, rather than the conditions themselves.

“We’re not saying that millions and millions of people have the disease. We’re saying millions and millions of people are at risk,” Clyde Yancy, MD, chief of cardiology at the Northwestern University Feinberg School of Medicine, told Health.

Here’s what to know about CKM syndrome, how prevalent it is in the U.S., and how to manage your risk.

<p>Prostock-Studio / Getty Images</p>

Prostock-Studio / Getty Images

How Many People Have CKM Syndrome?

To investigate just how common CKM syndrome is in the U.S., the authors of the JAMA research letter looked at data from the National Health and Nutrition Examination Survey between 2011 and 2020. They included health information from 10,762 adults, who were 47 years old on average.

This allowed the authors to sort participants into one of five different CKM syndrome stages.

About 10% of people had stage zero CKM syndrome, which actually means they met no criteria for the condition. These participants had a normal body mass index (BMI), a normal waist circumference, and no other risk factors.

Nearly 26% of people met the criteria for stage one, which meant they had elevated BMIs, a higher waist circumference, or prediabetes. These factors raise a person’s risk of developing heart disease, kidney disease, obesity, and/or type 2 diabetes.

“Stage zero and one are similar in terms of risk,” Ashish Verma, MD, assistant professor of nephrology at the Boston University Chobanian and Avedisian School of Medicine, told Health. “[They] are more risk stages than syndrome stages, as there is opportunity for prevention in these stages.”

The biggest proportion of participants—49%—had stage two CKM syndrome. They had kidney disease, and/or metabolic risk factors such as high blood pressure, high triglycerides, type 2 diabetes, or metabolic syndrome.

Researchers found the final 15% of the participants had advanced-stage CKM syndrome. This includes stage three (about 6% of people), which is defined as very-high-risk kidney disease or a high risk for cardiovascular disease. About 9% of people had stage four, or established cardiovascular disease.

Black Americans, men, and people over the age of 65 had an increased risk for these advanced stages of CKM syndrome.

These prevalence statistics were consistent between 2011 and 2020.

The fact that there is a high burden of CKM syndrome in the U.S. “is not surprising,” Sadiya Khan, MD, professor of cardiovascular epidemiology at the Northwestern University Feinberg School of Medicine, told Health. However, this new research highlights just how common stage two CKM syndrome really is, she said.

Related: How Worsening Metabolic Syndrome—Including High Blood Sugar, Hypertension, and Obesity—Can Impact Cancer Risk

How Do You Prevent CKM Syndrome?

With CKM syndrome being a newer concept, researchers are still learning more about how it progresses.

There are many different risk factors and early warning signs associated with CKM syndrome, and “we don’t know what comes first,” Yancy explained.

Though obesity is a major driver for CKM syndrome in many people, that’s not always the case.

“Some people are predisposed without being overweight,” Matthew Weir, MD, division head of nephrology at the University of Maryland School of Medicine, told Health.

One person may first gain weight, and then go on to develop type 2 diabetes. Another may have kidney issues that lead to heart issues and weight gain. The relationship between all of these conditions is bidirectional, Verma said.

“Kidney disease is a risk factor for heart disease and vice versa,” he explained. “Metabolic disease is a risk factor for both kidney disease and cardiovascular disease.”

Because of this, there are a wide number of different CKM syndrome risk factors that doctors can address with their patients—usually lifestyle modifications can have a big impact. In some cases, medications, including Wegovy or Ozempic, might be necessary to help people manage obesity and diabetes, Weir said.

As people reduce risks for one area, such as obesity, they may be able to modify risks for other aspects of CKM syndrome, like heart disease, said Yancy.

Related: Weight-Loss Drug Wegovy Could Reduce Risk of Heart Attack, Stroke

Raising Awareness to Reduce Prevalence of CKM Syndrome

With evidence of just how common CKM syndrome is, experts hope the condition becomes more widely discussed, both among healthcare professionals and everyday people.

Doctors often treat specific aspects of a patient’s health without addressing the bigger picture, Weir explained. For CKM syndrome in particular, many healthcare professionals may not even be familiar with it, he added.

“CKM [syndrome] is a brand new way of thinking,” said Yancy. “If we modify risk factors and target the entire cascade, might that not be better?”

More awareness and focus on the overlap between these conditions should have a big impact on health, and hopefully reduce the percentage of people who meet the criteria for CKM syndrome.

This is especially important when it comes to reducing health disparities.

The JAMA study found very few people who identify as Black were included in the stage zero category, Khan pointed out.

“This really highlights the importance of earlier intervention beginning in childhood, or perhaps even in the prenatal period,” she said.

Focusing on social determinants of health could be one way to ease these disparities, Yancy said. This might mean increasing access to nutritious foods, creating more areas to walk, or expanding access to health insurance.

On an individual level, people should start a conversation with their healthcare provider about CKM syndrome if they think they fall into any of the stages—even stage one, said Yancy.

Any type of clinician should be able to address CKM syndrome, and your primary care doctor can refer you to a specialist if necessary, said Weir.

“It’s real, it’s comprehensive, and there are many, many people who really do fall into this category,” said Yancy.

Related: Understanding Racial Disparities in Heart Health

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