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Doctors Are Rethinking a Little-Known but Serious Health Condition
CKM syndrome links heart, kidney and metabolic health, including conditions such as high blood pressure, diabetes, kidney disease and excess weight
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Key takeaways
- Nearly 90 percent of U.S. adults have at least one risk factor for a recently defined health condition known as CKM. Risk factors include excess weight, high blood pressure, abnormal cholesterol, high blood sugar and reduced kidney function.
- Doctors say a new guideline should help them spot CKM risk earlier and treat related problems together instead of one at a time.
- Adults 50-plus should ask their doctor to review their blood pressure, cholesterol, blood sugar, kidney function and overall CKM risk.
Most people think of heart disease, kidney disease, type 2 diabetes, high blood pressure and obesity as separate health problems. But a new guideline says these health problems are often connected — and doctors should treat them that way and act early, before they worsen.
The American Heart Association (AHA) and the American College of Cardiology (ACC) have issued the first guideline for cardiovascular-kidney-metabolic syndrome, or CKM — a recently defined yet common health condition that affects nearly 90 percent of U.S. adults.
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With CKM syndrome, problems such as excess weight, high blood pressure, abnormal cholesterol, high blood sugar and reduced kidney function can build on one another, increasing the risk of heart disease, chronic kidney disease, heart failure, stroke and kidney failure.
“These risk factors and diseases come in clusters,” Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston, told AARP. “So if you start developing one, you’re at more risk of developing others.”
Here’s what CKM means, why it matters and what to ask at your next doctor’s visit.
What is cardiovascular-kidney-metabolic syndrome?
Many of us are familiar with heart disease, kidney disease, obesity and type 2 diabetes. These four health conditions are among the most common in the U.S. and are especially prevalent among older adults.
CKM syndrome describes what can happen when problems with the heart, kidneys and metabolism feed into one another. Extra weight, especially around the belly, can raise blood pressure, blood sugar and cholesterol. Those changes can strain the blood vessels, heart and kidneys. Kidney problems can then worsen blood pressure and heart risk.
Dr. Chiadi Ndumele, an associate professor of medicine and director of obesity and cardiometabolic research at Johns Hopkins University, told AARP that CKM syndrome is “a really potent driver” of premature deaths, including from heart disease.
The American Heart Association says 1 in 3 U.S. adults has three or more risk factors for CKM syndrome; nearly half of all adults are living with some form of heart disease.
New guidelines call for early intervention
Dr. Ambar Kulshreshtha, a physician-epidemiologist and primary care physician at Emory University School of Medicine, says the new recommendations are meant to change how these common conditions are managed.
“The aim of the new CKM guidelines is to move away from siloed care, where each problem is treated separately, toward a more coordinated management of overall CKM risk and greater emphasis on prevention across the life course,” says Kulshreshtha, who helped write the new guideline.
The new guideline is also meant to help doctors catch — and treat — those connections earlier, before bigger health problems develop.
For many people, that may mean lifestyle changes and better control of blood pressure, cholesterol, blood sugar and weight. For some patients, the guideline also points to treatments such as GLP-1-based medications, SGLT2 inhibitors (type 2 diabetes medications) or metabolic and bariatric surgery when appropriate.
Though treatments may vary depending on the individual, the goal is the same: to reduce strain on the heart, kidneys and metabolism and help prevent heart attack, heart failure, stroke and kidney failure.
The CKM syndrome spectrum
The new guideline breaks CKM syndrome into stages, so doctors can better understand a person’s risk and decide which prevention or treatment may help. You can also use the PREVENT risk calculator, which estimates your chance of developing cardiovascular disease over the next 10 and 30 years. The new guideline says it can help doctors look beyond heart risk alone because it includes kidney and metabolic health factors.
- Stage 1 includes people with overweight, obesity or prediabetes but no other metabolic risk factors, kidney disease or cardiovascular disease.
- Stage 2 includes people with one or more metabolic risk factors, such as high blood pressure, abnormal cholesterol or other lipids, type 2 diabetes or metabolic syndrome, and/or kidney disease but no cardiovascular disease.
- Stage 3 includes people with CKM risk factors and subclinical, or asymptomatic, cardiovascular disease. It also includes people with very-high-risk chronic kidney disease or a high predicted 10-year risk of cardiovascular disease, based on the PREVENT equations.
- Stage 4 includes people with diagnosed cardiovascular disease, such as coronary heart disease, heart failure, stroke, peripheral artery disease or atrial fibrillation, along with overweight or obesity, other metabolic risk factors or kidney disease.
Worried about CKM? Talk to a primary care doctor, cardiologist, kidney specialist, diabetes specialist or obesity medicine specialist.
“Primary care is the ‘medical home’ for the majority of patients and is an ideal setting for risk assessment, emphasizing prevention and care coordination,” says Kulshreshtha.
What to ask your doctor
If you are 50 or older and have high blood pressure, prediabetes, diabetes, kidney disease, excess weight, abnormal cholesterol or a history of heart disease, ask your doctor: “Can we review my heart, kidney and metabolic risk together?”
Kulshreshtha says patients can make that conversation more specific by asking how their risk should be assessed and what can be done now.
“A 50-plus-year-old patient can ask their physician regarding how their cardiovascular, kidney, and metabolic health can be reviewed more comprehensively to determine their CKM stage, overall risk and prevention strategies,” he says. “What lifestyle changes and treatments can help protect both the heart and kidneys at the same time?”
You can also ask whether you should be assessed or reassessed for CKM risk, which CKM stage you may fall into and whether you should use the PREVENT risk calculator. Ask whether your blood pressure, cholesterol, blood sugar, kidney function and urine protein have been checked.
Two checks may be easy to miss in a routine visit, Kulshreshtha says. The first is a waist-hip measurement. “Another important one is urine microalbuminuria, which is a key early marker of silent kidney disease that can substantially elevate cardiovascular risk, and it remains underutilized despite its clinical importance,” Kulshreshtha says.
If you take medication, ask whether your treatment plan addresses heart, kidney and metabolic risk together. And if you see several doctors, find out who is coordinating the plan.
Editor’s note: This story, first published June 13, 2024, has been updated to include new information.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
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