The American Heart Association (AHA) has identified a new medical condition called cardiovascular-kidney-metabolic (CKM) syndrome, which reflects a strong link between cardiovascular disease (CVD), kidney disease, type 2 diabetes and obesity.
The new multisystem heart disease was identified to improve early diagnosis, intervention and treatment for people at high risk of dying from heart disease, the AHA said in an advisory Monday.
One in three adults in the U.S. have three or more risk factors contributing to cardiovascular disease, metabolic disorders and/or kidney disease, according to AHA.
“CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart, and more,” the association said in a news release.
Type 2 diabetes and obesity are the metabolic risk factors of CKM, which are known risk factors of cardiovascular disease. Also, cardiovascular disease is the primary cause of death among people with Type 2 diabetes and chronic kidney disease.
“We’re seeing the health consequences of all these conditions interacting and leading to earlier presentations with heart disease,” Dr. Chiadi E. Ndumele, the director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University and the lead author of the AHA advisory, told NBC.
“Reducing the pipeline of individuals progressing to heart disease is our primary goal,” Ndumele said, adding recognizing the interactions of these overlapping conditions will be “a paradigm change.”
“We now have several therapies that prevent both worsening kidney disease and heart disease. The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome,” Ndumele noted.
Stages of CKM
- Stage 0: The risk of CKM is zero and the focus should be on preventing the syndrome by following AHA’s Life’s Essential 8 recommendations: Healthy eating, being physically active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, blood pressure and blood sugar levels.
- Stage 1: This stage is when someone has excess body fat, abdominal obesity or prediabetes. People in this stage are advised to achieve 5% weight loss and get treatment for glucose intolerance if required. Screening for blood pressure, triglycerides, cholesterol and blood sugar every two to three years is also recommended.
- Stage 2: This is the stage when a person has type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and is at a higher risk of worsening kidney disease and heart disease. At this stage, the focus should be on preventing disease progression and kidney failure through medications to protect the kidneys, control blood pressure, blood sugar and cholesterol and achieve weight loss. It is recommended to get tested for blood pressure, triglycerides, cholesterol, blood sugar and kidney function every year at this stage.
- Stage 3: This is the stage of early cardiovascular disease without obvious symptoms. It is important to intensify efforts to prevent disease progression to symptomatic cardiovascular disease and kidney failure. Recommendations include increasing or changing medications, with an additional focus on lifestyle changes. With lifestyle changes and weight loss, CKM may regress to lower stages.
- Stage 4: At this stage, some people might have already had a heart attack or stroke. They may also have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. There are two subcategories of stage 4, those with kidney failure and those without it. Providing individualized treatment is key here.
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