What Is CKM Syndrome and Could You Have It?

Recent research from Mass General Brigham shows that about 90% of people already have a newly defined health condition called cardiovascular-kidney-metabolic (CKM) syndrome. This diagnosis puts them at risk for a cluster of connected health conditions: heart disease, kidney disease, diabetes, and obesity.

“Patients will need to make important lifestyle changes such as diet and exercise and talk to their doctors about therapies to prevent further progression of CKM syndrome,” says Rahul Aggarwal, MD, a Mass General Brigham cardiovascular medicine fellow training at Brigham and Women’s Hospital. Dr. Aggarwal is the lead author on recent research into CKM syndrome. “Recognizing what stage of CKM syndrome you have and talking about it with your doctor can really make a difference in being able to identify the condition early and prevent further progression of disease,” he adds.

This advice may be especially important for men and Black adults, because the study found that they’re more likely to have advanced CKM syndrome than others.

What is cardiovascular-kidney-metabolic syndrome?

The American Heart Association (AHA) recently defined CKM syndrome as “a health disorder due to connections among heart disease, kidney disease, diabetes, and obesity leading to poor health outcomes.”

The health conditions were previously considered separate problems and are often managed separately. With this new designation, the AHA wants people to understand that the conditions are closely connected. They can worsen each other and lead to serious outcomes, such as heart attack, stroke, heart failure, and abnormal heart rhythms. However, lifestyle changes and treatments can help improve each condition individually and CKM syndrome as a whole.

How common is CKM syndrome?

Few studies have explored CKM syndrome and how common it is. Dr. Aggarwal partnered with John Ostrominski, MD, a Mass General Brigham cardiovascular medicine research fellow also training at Brigham and Women’s Hospital, and Muthiah Vaduganathan, MD, MPH, a Mass General Brigham specialist in cardiovascular medicine at the Brigham and Women’s Heart and Vascular Center, to better understand the prevalence of CKM syndrome.

They used data from the National Health and Nutrition Survey, which includes information from physical examinations, bloodwork, and interviews from a nationally representative group of more than 10,700 adult patients.

According to their study results, published in JAMA:

• About 90% of patients in the United States have CKM stage 1 or higher, and 15% of people have advanced stages of CKM syndrome.

• Adults 65 years and older are more likely to have the syndrome.

• Black adults are more likely to have advanced CKM syndrome than adults of other races (18.9% among Black adults versus 14.7% for Hispanic adults, 13.8% for white adults, and 11.4% for Asian adults).

• Men are more likely to have advanced CKM syndrome than women (16.9% versus 12.4%).

• Almost 80% of young adults (ages 20–44 years) already have CKM syndrome risk factors.

• The syndrome was just as common at the end of data collection (2020) as it was at the beginning of data collection (2011), indicating a lack of progress in prevention and management.

In the publication, the researchers called for healthcare approaches that prioritize CKM health, especially for Black patients.

“There have been historic injustices to the Black community that have led Black adults into more marginalized communities where access to food, transportation, and health care resources is more limited,” Dr. Ostrominski says. “This has led to a widening of health disparities, as we see in this study of CKM syndrome.”

Stages of CKM syndrome

The AHA recently created a staging system for CKM syndrome. The stages can help you and your health care providers better understand your health and how aggressively you need to address it.

• Stage 0: No risk factors for CKM syndrome

• Stage 1: Excess body fat, especially around the waist

• Stage 2: Type 2 diabetes, kidney disease, high triglycerides, metabolic syndrome, or high blood pressure

• Stage 3: Early signs of cardiovascular disease or at high risk of developing it

• Stage 4: Diagnosed cardiovascular disease, with or without kidney failure

“This is a very useful framework for patients because you can use it as a tool to keep track of your risk over time. This can help you and your health care providers decide how aggressive to be in monitoring, preventing, and managing certain things — whether that’s through lifestyle changes, screening tests, or therapies that can help prevent the progression of disease,” Dr. Ostrominski says.

Risk factors for cardiovascular-kidney-metabolic syndrome

To protect and improve your health, it’s important to understand the risk factors for CKM syndrome:

• Diabetes

• Extra body fat, especially around the waist

• High cholesterol

• High blood sugar, called non-diabetic hyperglycemia

• High triglycerides (a type of fat in the bloodstream)

• High blood pressure (hypertension)

• Obesity, defined as a body mass index of 30 or higher

The AHA developed an online calculator that you and your doctor can use to understand your risk: the Predicting Risk of cardiovascular disease EVENTs (PREVENT™) equation. The resulting score can prompt important conversations about lifestyle changes and treatments to prevent or slow CKM syndrome.

Importance of controlling body weight

One of the main ways to prevent CKM syndrome is to control your body weight through diet and exercise. Maintaining a healthy body weight reduces your risk of high blood pressure, high cholesterol, and diabetes — and therefore CKM syndrome.

“When we think about a healthy diet and regular exercise, these are not only opportunities to prevent cardiovascular disease. They’re opportunities to prevent just about every condition along this CKM spectrum — cardiovascular disease, kidney disease, and metabolic conditions like obesity and diabetes,” Dr. Ostrominski says.

Dr. Aggarwal encourages people to make these changes early. Their study found that most young people already have risk factors. Plus, the earlier you implement changes, the less likely you are to develop the conditions that lead to CKM syndrome. “At a younger age, prevention measures such as lifestyle changes or medications can have substantial long-term benefits for improving CKM health,” he says.

Treatment for advanced CKM syndrome

People with more advanced stages of CKM syndrome require care from multiple specialists. The care team may include nephrologists for kidney disease, endocrinologists for diabetes, and cardiologists for heart conditions. These specialists may recommend various treatments, depending on your individual needs:

• Medications to manage blood pressure, cholesterol, blood sugar, or weight loss — especially newer medications that treat both diabetes and obesity

• Bariatric surgery

• Dialysis for kidney function

• Referral to a nutritionist or dietician

“Initially, we thought of all of these conditions as one plus one plus one. If you have hypertension, that’s one. You have diabetes. That’s another one. But we’re seeing that the clustering of these conditions is very common and that the clustering of them can make it more challenging to treat,” says Dr. Ostrominski. “But it also means that if you treat one of the conditions, you might see improvements in other conditions as well.”