Cardiovascular-Kidney-Metabolic Syndrome

As a former ICU registered nurse and clinical director of a Pritikin Intensive Cardiac Rehab (ICR) program, I have spent years recognizing and educating patients about risk factors that lead to the development of cardiovascular disease (CVD). The most rewarding part was educating my patients on how to slow the disease progression by adopting healthier lifestyle choices.  Many of my previous cardiac rehab patients came to the program unknowingly suffering from metabolic syndrome. This disorder involves a combination of risk factors such as elevated blood sugar, triglycerides, and blood pressure, along with low levels of HDL (the “good” cholesterol) and an above-average waist circumference.

However, that is only one piece of a much larger puzzle of associated health conditions. The direct relationship between the health of our heart and kidneys (cardiorenal syndrome) is well-documented. But recently, this confluence of metabolic and kidney conditions and their elevated risk of mortality from cardiovascular disease has captured healthcare’s attention.

On  October 9, 2023 the American Heart Association (AHA) published a Presidential Advisory on Cardiovascular Kidney Metabolic Health (CKM). CKM syndrome identifies links between a patient’s metabolic risk factors. These links can predict one’s probability of developing serious kidney and cardiovascular conditions. The new term also reflects new guidance for screening and treatment.

What is CKM Syndrome?

According to AHA’s CKM Health initiative co-chairs, Dr. Janani Rangaswami, a nephrologist, and Dr. Chiadi Ndumele, a cardiologist, CKM Syndrome is a systemic condition derived from a cluster of metabolic risk factors such as obesity, diabetes, hypertension, chronic kidney disease (CKD), and cardiovascular disease. When combined, they can have a detrimental effect on multiple organs of the body and result in increased mortality from cardiovascular disease. Unfortunately, at least one-third of American adults already have three or more of the components that can lead to the high mortality risk associated with CKM Syndrome. Individually, obesity, diabetes, and hypertension, in and of themselves, can put a person at risk for cardiovascular disease.  Layer on kidney disease and this risk is multiplied significantly. According to Dr. Rangaswami, 90% of people with CKD are completely unaware they have the disease.

 

How do we identify CKM Syndrome?

Unlike metabolic or cardiorenal syndromes, the presidential advisory explains that CKM syndrome includes the time before the onset of any symptoms, stressing the importance of screening for metabolic factors at an early age. This includes not only looking at the biological issues at play but also the social determinants of health (SDOH) that affect clinical outcomes. These can include financial hardships and environmental, social, and psychological factors that can put a person at an increased health risk. To help assess risk for CKM, the AHA has created the staging system outlined below. The goal in all stages is to prevent progression to the next stage and, especially, to the diagnosis of CVD or CKD.

Stage 0: No Risk Factors 

• In this stage, individuals are typically young, asymptomatic with normal weight, no metabolic risk factors, or diagnoses of CKD or CVD.
•  These individuals would benefit from early preventative screenings for biological metabolic factors and SDOH. They should be encouraged to adopt heart-healthy lifestyle behaviors in order to maintain a low risk of developing CVD.

Stage 1: Excess/Dysfunctional Adipose Tissue