American Heart Association Throws Light on Newly Discovered Medical Condition: CKM Syndrome

Do you have cardiovascular-kidney-metabolic (CKM) syndrome?

Last week, the American Heart Association (AHA) announced the classification of a group of common chronic health issues.

The group defines cardiovascular-kidney-metabolic (CKM) syndrome as the intersection of kidney disease, type 2 diabetes, obesity, and cardiovascular disease.

In early stages, the syndrome is characterized as unhealthy weight distribution, while in later stages, people with CKM syndrome have serious health issues, such as heart or kidney failure.

The new classification calls attention to the connections between these four chronic illnesses.

“I think this is fascinating,” Ashish Verma, MD, assistant professor of medicine in the nephrology division and clinical researcher at the Boston University Chobanian and Avedisian School of Medicine, told Health.

“Most [patients] think that diseases like metabolic dysfunction or metabolic syndrome, kidney disease, or cardiovascular disease [are] very exclusive,” he said. “They are not—they’re very well connected to each other.”

Beyond defining the syndrome, the AHA statement highlights different ways that social and biological factors can influence someone’s CKM risk, and calls for a more “holistic” approach to care and prevention.

Here’s what experts had to say about the different stages of CKM syndrome, where the condition comes from, and how the AHA's new identification could change treatment for chronic diseases in the future.

CKM syndrome isn’t necessarily a new disease so much as it is a rebranding of existing conditions, Daniel Weiner, MD, a nephrologist at Tufts Medical Center, told Health.

“I don’t think there’s a whole lot [that’s] entirely new or novel here,” he said. “But it’s a really nice synthesis of the interactions on kidney disease, cardiovascular disease, diabetes, other metabolic risk factors and syndromes, and how they affect human health.”

Experts agree that grouping these four conditions together—cardiovascular disease, kidney disease, and metabolic syndromes, or type 2 diabetes and obesity—makes a lot of sense.

As Weiner said, there are “connections within connections” between the conditions.

High blood pressure, fat deposition, and insulin resistance lay the groundwork for CKM syndrome, Verma explained. These risk factors can lead to obesity and type 2 diabetes, which in turn can cause inflammation and stress in the body that can worsen kidney and heart function, he said.

Yet, metabolic issues aren’t the only thing driving CKM syndrome. Heart disease and kidney disease also play a key role.

“We know metabolic syndrome causes kidney disease. Metabolic syndrome causes cardiovascular disease also,” explained Verma. And kidney and heart diseases have a “bi-directional relationship” of risk, he added.

Beyond the definition, the AHA statement also includes parameters for how the syndrome progresses.

“Stage zero is regarding prevention,” said Verma. He explained that this stage includes people who are not eating well, not exercising, not sleeping well, have an unhealthy body mass, and have adiposity—risk factors for the conditions within CKM.

He noted that the point of having a stage zero is to prevent people from developing CKM syndrome and to raise awareness of risky lifestyle behaviors.

Stage one includes people with abdominal obesity or some glucose impairment, such as prediabetes.

Stage two of CKM syndrome encompasses people with type 2 diabetes, high blood pressure, high triglycerides, or kidney disease. This stage is at risk of developing worse kidney disease or cardiovascular disease.

By stage three, people with CKM syndrome have either cardiovascular disease without symptoms, kidney disease, or are at a high risk of developing cardiovascular disease.

Stage four includes people with cardiovascular disease. The stage is further subdivided into those with and without kidney failure—at this advanced stage, people may have already had a heart attack, stroke, heart failure, or other cardiovascular event.

According to the AHA, CKM syndrome stems from high rates of obesity and type 2 diabetes in the U.S.

However, when defining such wide-ranging chronic illnesses, the AHA also emphasized the fact that there are a host of differences that can impact a person’s risk and presentation of CKM syndrome.

On the individual level, risk factors may not present equally. For example, one person with excess weight may not have any other metabolic risk factors, while someone else in a normal weight range could have insulin resistance and other metabolic risk factors.

The organization also acknowledged that broader social factors can affect someone’s CKM syndrome risk.

Race, socioeconomic status, education, neighborhood, and other factors likely play a role. In the statement, the AHA noted that people with Asian ancestry experience often experience the same risk factors as other ethnic groups with a lower body mass index.

Additionally, Black Americans have higher risks of both obesity and type 2 diabetes conditions as compared to white Americans.

Overall, the organization believes that about 33% of adults have at least three risk factors for the syndrome.

The AHA statement has a “particular focus on identifying people at early stages of CKM syndrome,” Chiadi Ndumele, MD, PhD, AHA writing committee chair and an associate professor of medicine at Johns Hopkins University, said in a press release.

The goal is to catch these cases before they become serious.

To do this, the AHA suggests cardiovascular risk be evaluated in people as young as 30, in both 10- and 30-year risk increments.

Additionally, the organization urged doctors to use kidney function tests, type 2 diabetes blood tests, and other “social determinants of health” to paint a more accurate picture of someone's risk of cardiovascular disease.

Beyond prevention and early diagnosis, establishing CKM syndrome also clarifies the way that we think about treatments that already “act on this axis of cardiovascular, metabolic, and kidney,” said Verma.

Americans now have access to SGLT2 inhibitors—sold as Jardiance, Forxiga, and Invokana—as well as GLP-1 inhibitors, such as Wegovy or Ozempic, Weiner explained. These drugs are best known for treating type 2 diabetes, but they can also help a person lose weight and lower the risk of both cardiovascular and kidney disease. 

“They’re really very novel compared to anything we’ve had before,” Marvin Konstam, MD, chief physician executive of the CardioVascular Center at Tufts Medical Center, told Health. “In my own view of it, it actually gets at the root cause of this problem—the metabolic-cardiovascular disease problem—not just blood sugar and diabetes.”

Ideally, CKM syndrome will make it easier for doctors to treat people holistically, and be more aware of the ways that cardiovascular, kidney, and metabolic diseases interact with one another.

“[It’s] more inclusive, and more towards multidisciplinary care, rather than more exclusive [care],” Verma said.