A Common Health Disorder You’ve Probably Never Heard Of

Even if they seem relatively distant in their positions in our bodies and autonomous in their roles, our organs are intimately, intricately connected. The gut talks to the brain; the liver can affect the lungs; and the health of your heart can influence the health of your kidneys.

In fact, these last two — the heart and kidneys — are so closely intertwined that health experts have coined a new term to define patients who are at risk for their related illnesses. It’s called cardiovascular-kidney-metabolic syndrome, and research suggests it’s exceptionally common.

The American Heart Association says 1 in 3 U.S. adults have three or more risk factors for CKM syndrome, and it appears most adults are affected to some degree. In fact, a recent study published in the journal JAMA suggests nearly 90 percent of U.S. adults have some stage of CKM syndrome — a reflection of risk factors from being overweight to having chronic conditions like diabetes. 

What is cardiovascular-kidney-metabolic syndrome?

Most people 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 they are especially prevalent in older adults.

Are You at Risk?

To help people understand where they are on the CKM health risk spectrum specifically for heart disease, the AHA has a calculator.

You plug in your sex, age, cholesterol, blood pressure, body mass index (BMI) and a few other details, and the tool spits out your estimated 10- and 30-year percentage risk for developing cardiovascular disease or heart failure.

But they’re also closely connected, and CKM syndrome — a concept recognized and a term first coined in an advisory by the American Heart Association last fall — encompasses their overlap. To put it another way: If you have a metabolic disorder (metabolic just has to do with getting energy from food) like type 2 diabetes or obesity, your risk goes up for either developing heart and kidney problems, or worsening them. 

Chiadi Ndumele, an associate professor of medicine and director of obesity and cardiometabolic research at Johns Hopkins University, says CKM syndrome is “a really potent driver” of premature deaths, including from heart disease. Cardiovascular deaths — once on the decline — are now increasing, evidence suggests. “This is thought to be all secondary to CKM syndrome,” says Ndumele, who coauthored the AHA advisory.

The snowball effect

The causes and effects of CKM syndrome are wide-ranging. It’s not a simple flowchart but more of a spiraling storm — such as when obesity, a major cause of kidney disease, leads to a cascade of metabolic issues.

“When a kidney is damaged, by diabetes per se, or hypertension in particular, it produces a number of other abnormalities that affect the whole body — particularly the cardiovascular system,” says Katherine Tuttle, , professor of medicine in the division of nephrology at the University of Washington School of Medicine, and a coauthor of the AHA advisory. “It causes inflammation, it raises blood pressure, it makes people more resistant to insulin, it makes the lipid disorders worse.”

In turn, already high cholesterol levels can rise further; increasing insulin resistance inhibits the body’s ability to regulate blood sugar; and other changes take place — like kidney-disease-related calcium buildup in arteries\. Taken together, all these factors make circulation problems worse, which Tuttle says accelerates atherosclerosis, involving hardening and narrowing of the arteries, and heart failure.

“These risk factors and diseases come in clusters,” echoes Rahul Aggarwal, a cardiovascular fellow at Brigham and Women’s Hospital in Boston, who conducted the analysis for the JAMA research on the prevalence of CKM syndrome. “So if you start developing one, you’re at more risk of developing others. But they also improve in clusters as well.”

Lose weight or address an issue like high blood pressure with medication, and experts emphasize you could see health improvements that are wide-ranging.

The CKM syndrome spectrum 

The JAMA study analyzed a pool of 10,762 adults ages 20 and older from across the country. The researchers sorted these adults by their stage of CKM syndrome risk based on AHA criteria and found:  

• Stage 0: 10.6 percent had no CKM risk factors.

• Stage 1: 25.9 percent were assigned to the lowest level of CKM risk (besides not having it). This stage includes people who are overweight or who have obesity, who carry extra weight around their midsection, or who have higher than normal blood sugar levels.

• Stage 2: 49 percent of participants were classified as stage 2. These individuals met stage 1 criteria and also had metabolic risk factors, such as high triglycerides or blood pressure, diabetes or chronic kidney disease.

• Stage 3: 5.4 percent were considered to be at stage 3. These individuals met stage 1 and 2 criteria, plus they had some early “subclinical” signs of cardiovascular disease, such as calcium buildup detected in the arteries.

• Stage 4: 9.2 percent were considered to be at stage 4. This is the highest level of CKM risk that includes stage 1, 2 and 3 risk factors, plus cardiovascular disease, which could be anything from arrhythmia to heart failure.

“CKM syndrome occurs along a spectrum,” Ndumele says. What’s more, several nonmedical risk factors can influence where you fall on that spectrum, including economic stability, education access and quality, health care access and quality, and where a person lives and works. 

Reversing CKM syndrome

If you find yourself on the CKM spectrum, it’s important to know that you are not destined to move to higher stages, or even to stay where you are, Aggarwal says.

For people who have some risk factors but don’t yet have heart or kidney disease, one of the biggest things is incorporating lifestyle changes, Aggarwal says, like exercising 150 minutes a week. That can help with losing weight and managing or preventing chronic conditions like diabetes.

For those who do have more advanced risks related to everything from diabetes to high cholesterol, experts recommend talking to your doctor about whether medications could help, in addition to lifestyle changes.

For example, there are medications that can help manage high blood pressure, high blood sugar and high cholesterol, and treating these individual conditions can lower your risk for other related issues. There are also medications that can help people lose weight, and research suggests these drugs may also affect heart and kidney problems.  

A recent study evaluated the effect of semaglutide (the active ingredient in the diabetes medication Ozempic and the weight loss medication Wegovy) in patients with chronic kidney disease and type 2 diabetes. Published in the New England Journal of Medicine in May, the study found the medication had significant benefits not only for addressing kidney disease but also for preventing cardiovascular deaths.

“Kidney disease is probably one of the one of the strongest — if not the strongest — risk factors for cardiovascular disease,” says Tuttle, who was involved in the study. “If you can restore kidney health, then you have the opportunity for everything else to get better too.”