‘Connections among conditions’ – Heart Association defines cardiovascular-kidney-metabolic syndrome

The American Heart Association published this graphic to illustrate the five stages of cardiovascular-kidney-metabolic syndrome, or CKM.
_{© American Heart Association}

Physicians must consider the interplay of the heart, kidneys, diabetes and weight in a new approach to patient care, according to the American Heart Association (AHA).

Cardiovascular-kidney-metabolic syndrome is defined in a new AHA presidential advisory, a scientific statement, and news release published this week. Researchers cited dozens of studies on health conditions affecting millions of Americans – and primary care will be part of research, definitions and treatment now and in the future.

“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” Chiadi E. Ndumele, MD, PhD, MHS, FAHA, said in news release. Ndumele is writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore.

Chiadi E. Ndumele, MD, PhD, MHS, FAHA
_{© American Heart Association}

“Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease,” Ndumele said.

CKM recognizes the overlap among cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), and obesity. They affect “nearly every major organ in the body,” in millions of people, with one in three American adults having three or more risk factors that contribute to CVD, CKD, or metabolic disorders.

Collaboration needed

For effective treatments, AHA called for greater health care interaction and collaboration, with primary care, pediatrics, nephrology, cardiology and endocrinology all to be involved.

“There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”

The new AHA documents focus on adult health, but screening for CKM should start early in life to enhance prevention and management in youths and adults. For patient weight, AHA recommended lifestyle modification and weight loss to prevent progression of CKM, and possibly cause regression. The newest antiobesity drugs may be appropriate for patients with CKM, CVD, or high predicted CVD risk.

Social determinants of health (SDOH), also called social drivers of health, also make a difference. AHA emphasized SDOH screening and incorporating SDOH into risk prediction.

“Integrating SDOH into the holistic approachtoCKMcarewillenhancethereal-world effectiveness of therapeutic approaches and promote health equity,” the AHA presidential advisory said.

Five stages

AHA outlined five stages of CKM.

• In Stage 0, patients have no CKM risk factors.
• Stage 1 patients have excess body fat and/or unhealthy distribution of body fat, such as abdominal obesity; and/or impaired glucose tolerance or prediabetes.
• Stage 2 includes T2D, high blood pressure, high triglycerides and kidney disease, with greater risk of worsening kidney disease and heart disease.
• Stage 3 has early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or at high predicted risk for CVD. “The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure,” according to AHA.
• Stage 4 is divided into two categories for people with or without kidney failure. It includes symptomatic CVD in people with excess body fat, metabolic risk factors or kidney disease. Patients may have had a heart attack or stroke or may have heart failure, peripheral artery disease, or atrial fibrillation.