Susan Gilchrist, a preventive cardiologist and epidemiologist, regularly meets patients at the University of North Carolina’s Cardiovascular-Kidney-Metabolic (CKM) Syndrome Clinic who are often unaware of what CKM even means, and, honestly, why they’re there. This is hardly surprising since CKM syndrome was only defined in 2023 by the American Heart Association (AHA). It’s estimated that about 90% of U.S. adults—roughly the same number that may have the condition—have never heard of it.
CKM syndrome isn’t a single disease but rather an umbrella term that acknowledges the interconnectedness of cardiovascular, kidney, and metabolic conditions, including diabetes and obesity. Muthiah Vaduganathan, a cardiologist at Brigham and Women’s Hospital, points out that it reflects a growing understanding that factors like extra weight, high blood pressure, high blood sugar, abnormal cholesterol levels, and reduced kidney function can all play a role in these diseases’ development.
On a brighter note, Vaduganathan mentions that therapies addressing issues across the CKM triad can often overlap, meaning a singular approach can help manage multiple conditions.
How does CKM syndrome start and progress?
Researchers have identified CKM syndrome as a four-stage continuum, marking how symptoms and risk factors cumulatively increase the likelihood of heart issues or kidney failure.
- Stage 1: This stage includes individuals with excess body fat, defined as a body mass index (BMI) of 25 or more, or waist measurements exceeding 88 centimeters for women and 102 for men. It also includes those with “dysfunctional” fat who may not be heavier but display poor glucose tolerance, such as prediabetes. Notably, BMI doesn’t differentiate between body types, so experts often consider additional metrics to accurately assess risk.
- Stage 2: This involves individuals with metabolic risks, often stemming from extra fat, like elevated triglycerides, hypertension, metabolic syndrome, diabetes, or chronic kidney disease. Surprisingly, many remain asymptomatic at this point. A blood test during a routine physical usually helps categorize individuals here.
- Stage 3: This includes those from earlier stages who have developed presymptomatic heart disease, such as atherosclerosis, or who face a high risk (over 20%) of a heart event within the next decade, as indicated by the AHA’s PREVENT calculator. Due to the silent nature of the disease at this phase, classification usually happens when doctors order screenings based on risk factors.
- Stage 4: Here, we find individuals diagnosed with serious conditions like stroke, heart failure, or coronary artery disease. This stage, which may or may not involve kidney issues, signifies the most severe outcomes of CKM syndrome and carries a heightened risk for future heart events.
This classification helps Gilchrist clarify for patients why weight is significant for health. Extra weight on its own doesn’t necessarily indicate disease, but it can lead to it. Especially concerning are large waist sizes and heightened blood sugar levels, which indicate “metabolically dangerous” fat that releases inflammatory substances into the bloodstream, pushing the body into a stress state, she explains.
This combination can further elevate blood pressure and certain fats in the blood, causing insulin resistance and leading to even more sugar in the bloodstream—consequently damaging the kidneys and affecting their waste filtration. Such complications can result in increased blood volume, stressing the heart and worsening blood pressure over time, essentially setting off a downward spiral toward heart events and kidney failure, as noted by Joshua Joseph, an endocrinologist at Ohio State University.
Why is CKM syndrome becoming a more common diagnosis?
The CKM framework was established in 2023, with guidelines for identifying and managing it set for June 2026. It’s just starting to gain recognition among healthcare providers.
This syndrome potentially involves approximately 90% of Americans, capturing everyone from those feeling healthy but with early metabolic risk factors to those already dealing with heart disease. However, Vaduganathan points out this doesn’t imply all these individuals need treatment. The focus is on awareness—understanding that many are at risk for one or more metabolic, kidney, or heart conditions, emphasizing that proactive lifestyle changes can make a difference.
Gilchrist mentions that the guidelines even introduce a “Stage 0,” including the other 10% of Americans who aren’t technically classified as having CKM syndrome but are nonetheless at risk. Without committing to a healthy lifestyle, they could easily fall into the syndrome’s spectrum.
Joseph raises the point that many Americans find themselves between Stages 1 and 4 due to common lifestyle choices, including challenges in accessing nutritious food, staying active, or getting enough sleep. He also highlights that nearly 20% of U.S. adults use tobacco, further increasing health risks.
However, this behavior isn’t happening in isolation. Environmental factors play a significant role as well—living in places without grocery stores or safe areas for exercise, or even in areas polluted by factories. Joseph notes that both lifestyle and environmental aspects are critical levers for improving public health.
What are the treatments for CKM syndrome?
In early stages, treatment focuses on lifestyle changes. For instance, a Mediterranean-style diet has been shown not only to lower blood pressure and blood sugar but also to reduce long-term cardiovascular risks. The AHA also emphasizes the importance of physical activity, avoiding tobacco, and ensuring quality sleep, alongside weight loss programs for those who are overweight.
In higher-staged individuals, long-established medications targeting specific risk factors are still relevant, including metformin for blood sugar control, statins for cholesterol, and ACE inhibitors for blood pressure management.
Experts emphasize the growing array of medications designed for broader effects across organs, such as glucagon-like peptides (GLP-1s) that aid both weight and blood sugar management while benefitting the heart and kidneys. Sodium-glucose cotransporter 2 (SGLT2) inhibitors help eliminate sugar through urine and have been proven to stabilize kidney function, while nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) help manage fluid levels in the kidneys, benefiting the heart as well.
Gilchrist emphasizes that we’re in a promising era of medicine, as new drugs are not merely aimed at one risk factor but consider multiple aspects of risk management. Armed with the CKM framework, providers can identify at-risk patients and offer solutions that genuinely help them avoid hospitalization and live longer.
