Summary
Cardiovascular-kidney-metabolic (CKM) syndrome* is a newly recognized health disorder, disproportionately impacting those with adverse social determinants of health (SDOH). CKM presents a substantial public health threat, driven by rising rates of diabetes and obesity in the U.S. and worldwide, with increased morbidity and premature mortality associated with cardiovascular disease (CVD). To raise awareness of CKM syndrome, the American Heart Association published a presidential advisory outlining the definition of CKM, staging, screening, and approaches to care, all supported by evidence in a separate scientific statement.1,2
Stages of CKM range from 0-4 (Figure 1, Table 1), based on risk factors, BMI, A1C, lipids, and other factors. Risk-enhancing factors (Table 2) increase the likelihood of progression to later stages. Screening involves blood pressure assessment, lipid and glucose measurement, and evaluation of liver and kidney function (Table 3).
Detailed algorithms for treatment (Figure 3, Figure 4) are based on stage and comorbid organ involvement. Screening for and addressing SDOH (Table 4) are parts of the care model for patients with CKM.
Implementation strategies for CKM care are discussed, along with the need for broad support of interdisciplinary care, patient and clinician education, better access to novel pharmacotherapies and treatments for obesity, and support for healthy lifestyle changes in disproportionally affected communities.
*CKM is a systemic disorder characterized by pathophysiological interactions among metabolic risk factors, chronic kidney disease (CKD), and the cardiovascular system that lead to multiorgan dysfunction and a high rate of adverse cardiovascular outcomes. CKM syndrome includes individuals at risk for CVD due to the presence of metabolic risk factors, CKD, or both, and individuals with existing CVD that is potentially related to or complicates metabolic risk factors or CKD. The increased likelihood of CKM syndrome and its adverse outcomes is further influenced by unfavorable conditions for lifestyle and self-care resulting from policies, economics, and the environment.1
Sources
1Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a Presidential Advisory from the American Heart Association. Circulation. 2023;148:1606-1635. doi:10.1161/CIR.0000000000001184.
2Ndumele CE, Neeland IJ, Tuttle KR, et al.; on behalf of the American Heart Association. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a Scientific Statement from the American Heart Association. Circulation. 2023;148:1636-1664. doi:10.1161/CIR.0000000000001186.