A Brigham and Women’s Hospital team has published new research indicating that almost 90% of the adult U.S. population meets the criteria for stage 1 or higher cardiovascular, kidney, and metabolic (CKM) syndrome. The research also found significant disparities among Black adults and surprisingly high rates of the syndrome among young people.

Study authors John Ostrominski, MD, and Rahul Aggarwal, MD, fellows in cardiovascular medicine at Brigham and Women’s Hospital, and Muthiah Vaduganathan, MD, MPH, a specialist in cardiovascular medicine at the Brigham and Women’s Heart and Vascular Center, say this new information highlights the importance of recognizing CKM syndrome—a relatively new concept—and taking steps to prevent it.

“Historically, we have thought of metabolic conditions, kidney disease, and cardiovascular disease as isolated entities with different protocols for screening, risk stratification, and treatment,” Dr. Ostrominski says. “A key recent evolution is an increasing appreciation of the overlap of these conditions, which often occur together because they have shared risk factors and disease mechanisms. These overlapping disease pathways emphasize the potential for simultaneous prevention and treatment.”

They hope their findings will help increase clinical awareness of the syndrome, as well as clinical and public efforts to improve CKM health.

Stages of CKM Syndrome

In 2023, the American Heart Association (AHA) established the term “CKM syndrome” to recognize the complex interrelatedness among heart disease, kidney disease, obesity, and diabetes. The AHA also developed a novel staging system to risk-stratify patients:

• Stage 0: No risk factors for CKM
• Stage 1: Excess and/or dysfunctional adiposity
• Stage 2: Type 2 diabetes or metabolic risk factors, moderate- to high-risk chronic kidney disease, or both
• Stage 3: Stage 2 criteria, plus early signs of cardiovascular disease or a high risk of developing it
• Stage 4: Previous criteria, plus clinical cardiovascular disease, with or without kidney failure

“It may take some time for the medical community to get used to this way of thinking, but conceptualizing these as interrelated entities is extraordinarily important,” says Dr. Aggarwal. “The AHA’s new framework allows us to recognize the interplay between these different conditions and how risk in one territory increases risk in others. It also is very conducive to having conversations with other healthcare providers, and especially with patients.”

Prevalence of CKM Syndrome

Given the new staging system, the researchers wanted to establish a baseline understanding of the prevalence of CKM syndrome in the United States, any significant patterns, and potential disparities by sex, race, ethnicity, and age. The team analyzed data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey.

Their key findings, published in a research letter in JAMA found:

• About 90% of patients in the U.S. had CKM stage 1 or higher
• 15% of patients met criteria for advanced CKM
• The prevalence of CKM syndrome did not improve from 2011 to March 2020
• Black adults and men were more likely to have advanced CKM
• Only 18.2% of young adults (ages 20–44 years) had no risk factors

“All of this suggests that we need stronger public health measures and interventions to try to improve the cardiovascular-kidney-metabolic health of our patients,” says Dr. Aggarwal. “Having these baseline data is very important. When people look at the syndrome five or ten years down the road, we can understand from a public health standpoint if we’ve made progress in reducing the burden of the more advanced stages.”

Multidisciplinary Care of CKM Syndrome

Dr. Ostrominski suggests that clinicians review the Predicting Risk of cardiovascular disease EVENTs (PREVENT™) equation. The algorithm and online calculator, developed by the AHA’s CKM Scientific Advisory Group, can help clinicians assess risk in primary prevention patients aged 30 to 79. The resulting score can help facilitate conversations with patients about lifestyle changes and pharmacotherapies to prevent or slow CKM syndrome.

Recognition of CKM syndrome and subsequent management will require an integrated, non-siloed approach, he adds. “It may be that a cardiologist needs to practice a little bit of nephrology or endocrinology, and vice versa. Certainly, these individual pathways of care that have been historically siloed need to work more closely.”

The researchers also hope that the CKM construct will lead to broader awareness of therapies that prevent or treat more than one CKM condition. “There are several existing therapies that not only target several CKM conditions simultaneously, but when used for one CKM condition can prevent or delay the onset of the next. By improving CKM health, these therapies may be especially critical at early-stage disease for prevention of CKM syndrome progression,” Dr. Ostrominski explains.

Policy Changes

Dr. Aggarwal says the team hopes that heightened awareness of CKM syndrome will lead to changes in policy and perspective, such as:

• Encouraging lifestyle changes and pharmacotherapies that can reduce the risk of CKM syndrome
• Identifying ways to improve disparities in CKM syndrome, especially among Black patients
• Aligning clinician reimbursement to focus on quality of care, especially through incentivizing efforts to counsel patients and coordinate care among specialties
• Reducing overall costs and patient-level costs of therapies that can help reduce CKM risk
• Paying more attention to young adults, perhaps with more aggressive screening practices, more targeted counseling, and more preventative interventions
• Training healthcare professionals on CKM-oriented prevention and treatment

“CKM health in the U.S. is poor, and large-scale efforts are needed to identify early risk factors and provide targeted therapies to improve factors such as blood pressure, cholesterol, diabetes, weight, and kidney disease,” Dr. Aggarwal says. “Public health surveillance will need to continue to monitor patterns in CKM syndrome, which this study provides baseline population health metrics for.”