The American Heart Association (AHA) has identified a new medical condition to describe a mix of related health issues — cardiovascular disease, kidney disease, type 2 diabetes, and obesity — that can develop at the same time and increase the risks of heart attacks and strokes.
Awareness of this new condition, called cardiovascular-kidney-metabolic (CKM) syndrome, may help physicians recognize individuals who are at high risk for dying from heart disease at younger ages. In addition to considering the effects of cardiovascular disease (“C”) and kidney disease (“K”), this disorder factors in the impact of type 2 diabetes and obesity, known as metabolic conditions (“M”).
CKM syndrome prevention and treatment earlier in life may do the most to stave off serious health complications later, the AHA said in an advisory published in Circulation.
“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi Ndumele, MD, PhD, lead author of the advisory and an associate professor of medicine at Johns Hopkins University in Baltimore, in a statement. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”
To enable screening, AHA also created a four-stage system for identifying patients at risk for CKM syndrome:
- Stage 0: People have no risk factors for CKM syndrome. They should follow the AHA’s Life’s Essential 8 recommendations, which call for preventive measures like good eating and exercise habits, avoiding nicotine, and maintaining a healthy weight as well as optimal blood pressure, cholesterol, and blood sugar levels.
- Stage 1: People have overweight, an unhealthy distribution of body fat (such as excess belly fat), or impaired glucose tolerance or slightly elevated blood sugar levels known as prediabetes. In addition to lifestyle changes, they should aim to reduce their body weight by at least 5 percent and also take medications to manage blood sugar if needed.
- Stage 2: People have type 2 diabetes, high blood pressure, high triglycerides, or kidney disease. They should focus on lifestyle changes, weight loss, and medications to manage diabetes, blood pressure, and cholesterol levels, and to help preserve kidney function.
- Stage 3: People have early cardiovascular disease or kidney disease but aren’t experiencing symptoms. They may benefit from interventions used in earlier stages of CKM syndrome and as well as tests to measure artery health and treatments to help maintain good blood flow.
- Stage 4: People have cardiovascular disease or kidney disease and have experienced symptoms such as a heart attack, stroke, heart failure, or kidney failure.
In addition to identifying cardiovascular, kidney, and metabolic problems early, screenings are also intended to identify social and structural barriers to care. The AHA notes that CKM syndrome is particularly widespread in disenfranchised populations.
With CKM Syndrome, Lifestyle Changes Should Be a Priority
Assessing the risk of heart attack and stroke based on the combination of factors encompassed by CKM syndrome may help patients get a better understanding of how all of these conditions are related, says Sadiya Khan, MD, a professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine in Chicago.
This, in turn, may help patients realize how improvements in one area may have broader health benefits.
“We want to raise awareness that health is a spectrum and that the components included have a strong evidence base of being linked to risk of heart disease and dying from heart disease, so this is important for prevention,” Dr. Khan says. “One of the key ways we wanted to avoid this concern is by focusing on health and prioritizing the naming as CKM health stages.”
Across all stages of CKM syndrome, lifestyle changes are essential, Khan adds.
A heart-healthy lifestyle can include a diet rich in whole foods, fruits, vegetables, lean proteins, nuts, and seeds, according to the AHA. It can also involve getting at least 75 minutes a week of vigorous exercise like running, or 150 minutes of moderate exercise like walking briskly. Other lifestyle habits can help, too, like getting at least seven hours of sleep a night and avoiding tobacco.
“We don’t want any of the treatments in any of the stages happening without lifestyle changes as well,” Khan says. “That should be the priority across all the stages and should be integrated into all of the approaches, even when medications are used.”