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Here’s What to Know About Cardiovascular-Kidney-Metabolic Syndrome,
Newly Defined by the AHA
Howard Larkin
C
ardiovascular disease often occurs
with kidney disease and metabolic
diseases, including obesity and
type 2 diabetes. And having more than 1 of
these conditions multiplies health and mor-
tality risks, particu-
larly due to cardio-
Medical News website vascular disease.
An American Heart
Association (AHA) presidential advisory
recently published in Circulation newly de-
fines the adverse interplay among these con-
ditions as cardiovascular-kidney-metabolic
(CKM) syndrome.
The advisory provides guidance on how
to stage CKM syndrome in patients, predict
its cardiovascular outcomes, and effec-
tively manage, prevent, and even reverse it
in both adults and children. Evidence is de-
tailed in a separate scientific statement. To-
gether, the publications provide a frame-
work for holistically and equitably improving
CKM health in the population, according to
the advisory. They also lay the groundwork
for a new cardiovascular disease risk calcu-
lator that will incorporate the concept of
CKM health for the first time.
The Backstory
The advisory notes that the mutually rein-
forcing harmful relationships among meta-
bolic diseases, chronic kidney disease, and
cardiovascular disease are known. How-
ever, opinions have varied on how or to what veloped a consensus statement to clarify the Why This Matters
degree these conditions together consti- definition of CKM syndrome and the tools to Metabolic diseases—such as obesity and
tute a syndrome, which suggests a com- better detect, prevent, and manage it. They type 2 diabetes—and chronic kidney dis-
mon underlying pathophysiology. are included in the advisory and the scien- ease can damage nearly every major organ
“There has been increasing interest in the tific statement, which are the products of a system. In particular, they increase the risk
interplay among these conditions, but there multidisciplinary committee made up of 28 of cardiovascular diseases including heart
has not been a clear definition,” Chiadi E. experts in cardiology, nephrology, endocri- failure, atrial fibrillation, coronary artery dis-
Ndumele, MD, PhD, the advisory writing com- nology, primary care, and pediatrics. ease, stroke, and peripheral artery disease,
mittee chair, said in an interview with JAMA. The advisory attempts to bridge some- as well as the chance of premature death.
This has impaired treatment that addresses times inconsistent specialty-specific recom- Collectively, heart disease, stroke, kidney dis-
the entire CKM syndrome–risk spectrum, mendations, Ndumele said. “There was a ease, and diabetes directly accounted for
added Ndumele, who is an associate profes- lot of attention given to harmonization more than 1 million deaths in the US in 2021,
sor and director of obesity and cardiometa- across current guidelines. Where there or about 29%. Indeed, the increasing preva-
bolic research at Johns Hopkins University. were gaps or a lack of clarity, we identified lence of CKM-related risks has slowed 5 de-
To address the high and increasing those areas and then tried to provide clarity cades of decline in cardiovascular disease
prevalence of poor CKM health, the AHA de- wherever possible.” mortality, the advisory notes. And excess
jama.com (Reprinted) JAMA Published online November 8, 2023 E1
© 2023 American Medical Association. All rights reserved.
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