CKM Syndrome: American Heart Association's New Condition

Cardiovascular-Kidney-Metabolic (CKM) syndrome is a newly recognized health condition affecting millions of adults in the United States. About one in three American adults has multiple risk factors consistent with CKM syndrome, which links heart disease, kidney disease, diabetes, and obesity into a single interconnected disorder1 2. This syndrome highlights the complex interactions among these conditions and their combined impact on major organs, leading to increased risk of serious complications such as heart attacks, strokes, and kidney failure3 4.

Understanding CKM Syndrome

CKM syndrome is a systemic disorder defined by the American Heart Association (AHA) to address the overlapping pathophysiology and clinical management of cardiovascular disease, chronic kidney disease (CKD), and metabolic disorders like obesity and type 2 diabetes5 6. It reflects the multidirectional interplay of excess or dysfunctional adipose tissue (body fat), metabolic abnormalities, kidney dysfunction, and cardiovascular disease, which together contribute to multiorgan damage and increased morbidity and mortality7 83.

Dysfunctional adipose tissue releases inflammatory substances that promote chronic inflammation, oxidative stress, and insulin resistance. These processes damage the heart, kidneys, and blood vessels, accelerating the progression of metabolic, kidney, and cardiovascular diseases8 910. CKM syndrome affects nearly every major organ system, including the heart, kidneys, brain, and liver, leading to complications such as heart failure, arrhythmias, stroke, kidney failure, cognitive decline, and metabolic liver disease3 9.

The AHA has established a staging system for CKM syndrome to guide prevention and treatment strategies. The stages range from 0 (no risk factors) to 4 (clinical cardiovascular disease), with risk and severity increasing at higher stages11 3:

Screening for CKM risk factors across the lifespan is critical to identify individuals early and prevent progression to advanced disease12 10. The syndrome’s recognition encourages a shift from fragmented care of individual diseases toward integrated, multidisciplinary management addressing the entire metabolic-cardiovascular-kidney axis13 14.

“Recognizing what stage of CKM syndrome you have and talking about it with your doctor can really make a difference in being able to identify the condition early and prevent further progression of disease.”

— Rahul Aggarwal, Brigham and Women's Hospital4

CKM Syndrome Risk Factors

CKM syndrome arises from a complex interplay of metabolic, cardiovascular, and kidney-related risk factors. The syndrome is primarily driven by excess or dysfunctional adiposity, which triggers metabolic dysfunction including insulin resistance, hypertension, and dyslipidemia15 716. These metabolic abnormalities promote chronic inflammation and oxidative stress, which worsen cardiovascular and kidney disease8 .

Key risk factors for CKM syndrome include:

CKM syndrome is often underdiagnosed because its components are treated separately. Recognizing it as a connected syndrome enables earlier detection and coordinated care, improving outcomes for millions at risk2 4.

• Obesity, especially excess fat around the abdomen15 4
• Type 2 diabetes and insulin resistance15 16
• Hypertension (high blood pressure) 74
• Dyslipidemia, including high cholesterol and triglycerides4
• Chronic kidney disease or reduced kidney function7 16
• Metabolic syndrome, a cluster of metabolic risk factors16 3

Risk factors do not present equally among all individuals. For example, metabolic risk can occur even in people who are not obese, and ethnic differences influence risk profiles. Asian populations may develop metabolic risk factors at lower body mass index (BMI) thresholds, while Black Americans experience disproportionate burdens of obesity, diabetes, and advanced CKM syndrome due to social determinants of health17 18194.

Social and environmental factors play a prominent role in CKM syndrome risk. Adverse social conditions such as limited access to healthy food, healthcare, and transportation contribute to higher rates of cardiometabolic diseases and CKM multimorbidity in disadvantaged populations17 1819. Age and sex also influence CKM prevalence, with older adults and men more likely to have advanced stages of the syndrome20 4.

“There have been historic injustices to the Black community that have led Black adults into more marginalized communities where access to food, transportation, and health care resources is more limited. This has led to a widening of health disparities, as we see in this study of CKM syndrome.”

— John Ostrominski, Brigham and Women's Hospital4

Holistic Prevention and Treatment Approaches

The rising prevalence of obesity and diabetes across all age groups has contributed to widespread poor CKM health in the population12 2. About one-third of U.S. adults have multiple risk factors consistent with CKM syndrome, making prevention and early intervention critical21 22.

CKM syndrome requires a holistic, person-centered approach that integrates prevention, early detection, and multidisciplinary care. This approach addresses the interconnected nature of cardiovascular, kidney, and metabolic diseases rather than treating each condition in isolation13 142.

💡 Did You Know? CKM syndrome affects most major organs including the heart, kidneys, brain, and liver, with symptoms ranging from chest pain and swelling to fatigue and sleep apnea1 .

Key strategies for prevention and treatment include:

• Lifestyle modifications such as healthy eating, regular physical activity, and weight management9 23
• Controlling blood pressure, blood sugar, cholesterol, and triglycerides through medications when needed9 22
• Use of novel therapies like SGLT2 inhibitors and GLP-1 receptor agonists, which provide benefits across metabolic, cardiovascular, and renal outcomes24 9
• Regular screening for CKM risk factors and staging to guide intensity of interventions25 12
• Addressing social determinants of health to reduce disparities in CKM syndrome burden17 19

Early-stage CKM syndrome (stages 0 and 1) focuses on lifestyle changes to reduce excess adiposity and improve metabolic health. Middle stages (2 and 3) require risk factor management and early cardiovascular interventions. Advanced stage 4 involves managing clinical cardiovascular disease and potential kidney failure with specialized care11 4.

“At a younger age, prevention measures such as lifestyle changes or medications can have substantial long-term benefits for improving CKM health.”

— Rahul Aggarwal, Brigham and Women's Hospital4