CKM Syndrome: An Unrecognized Condition

Have you heard of cardiovascular-kidney-metabolic (CKM) syndrome? If not, you’re not alone. The American Heart Association (AHA) only named this medical condition, which links four different health problems, in 2023.

CKM affects almost all Americans. So, it’s a condition you need to know more about.

Recently, the AHA released guidelines that can improve CKM treatment and prevention. Board-certified cardiologist Anthony Bashall, MD, who sees patients at Franciscan Health Indiana Heart Physicians, explained why it’s important to know about CKM and how you can reduce your risk. 

Key Takeaways: Cardiovascular-Kidney-Metabolic Syndrome

• Four connected conditions — cardiovascular disease, kidney disease, obesity and type 2 diabetes — contribute to CKM syndrome.
• Recent research indicates that excess weight is the biggest contributing factor for the progression of CKM syndrome.
• Healthy lifestyle behaviors, medications and surgery can prevent or help manage CKM syndrome. 

What Is Cardiovascular-Kidney-Metabolic Syndrome?

CKM syndrome is a serious, complex medical condition. It links together four health problems: cardiovascular disease, kidney disease, obesity and type 2 diabetes. 

The connection between these conditions is your blood. The nutrients you eat travel through the blood that circulates throughout your body. Then, your kidneys filter waste from your blood. As a result, any one of these health problems can make the others worse. 

Having CKM syndrome is more dangerous than if you have just one of its contributing conditions. Over time, the combined impact from these health problems builds up. As a result, late-stage CKM can cause a heart attack or stroke. 

What Are The Risk Factors For Cardiovascular-Kidney-Metabolic Syndrome?

According to the AHA, roughly 90 percent of Americans have at least one risk factor for CKM syndrome. These can include:

• Diabetes
• High blood pressure
• High cholesterol
• Kidney disease
• Liver disease

But the biggest underlying culprit is excess fat and how it affects your organs, Dr. Bashall said. It doesn’t matter if the weight gain comes from your diet, genetics or age-related changes like menopause. When fatty tissue builds up around your heart, kidneys or liver, it causes inflammation. This damage increases your risk for a wide variety of other problems, including:

• Atrial fibrillation (AFib)
• Cancer
• Heart failure
• Neurological disease
• Sleep apnea
• Stroke

“CKM syndrome is a collective set of issues. As people gain weight, it harms the body,” Dr. Bashall said. “The whole point of calling it a cardiometabolic condition is to emphasize how all the weight-related effects from this syndrome can hurt your heart.”

What Are The Symptoms Of Cardiovascular-Kidney-Metabolic Syndrome?

With CKM syndrome, you can experience a mix of symptoms linked to its four connected conditions. These signs can include:

• Chest pain
• Fainting
• Fatigue
• Gout
• Loss of appetite
• Needing to urinate more often
• Pain in your legs
• Shortness of breath
• Swelling in your ankles, hands, feet or legs

Why Catching CKM Syndrome Early Matters

CKM syndrome can affect anyone, and the beginning stages don’t produce symptoms. So, it’s important to talk with your doctor about your potential risks and to start to track your vital signs as early as possible, Dr. Bashall said.

“The most important stage — stage 0 — often gets neglected. But this is when you’re healthy,” he said. “Your blood pressure is good. Your cholesterol is good. Your weight is good. The goal for you and your doctor is to work together to keep you in stage 0.”

CKM syndrome has five stages:

• Stage 0: You’re healthy with no risk factors.
• Stage 1: You’ve gained a bit of weight, especially around your waist, have insulin resistance or prediabetes
• Stage 2: You’ve developed high blood pressure, high cholesterol, kidney disease, type 2 diabetes.
• Stage 3: You have (or are at risk) for heart disease, but you don’t have symptoms.
• Stage 4: You have excess body fat and symptoms of heart disease.

The conditions that contribute to CKM syndrome are silent until they reach an advanced stage. It is critical to catch them early, Dr. Bashall said.

“If we can unmask high blood pressure, cholesterol, fatty deposits in the liver or calcification in your blood vessels, then we can treat them early,” he said, which points to the importance of blood tests and heart or liver scans. “This way, we can prevent the progression of these problems later on and, hopefully, reduce your chances of CKM syndrome.” 

The Heavy Impact Of Weight And How Medication Can Help

Excess weight puts significant stress on your body, Dr. Bashall said. It raises your blood pressure and cholesterol and interferes with how your body processes blood sugar. Those extra pounds also lead to low levels of chronic inflammation that can damage your heart and other organs.

You can help improve your CKM-related symptoms if you lose weight. But research shows that diet and exercise can only help so much. 

“For most people, diet and exercise only lead to a 5 percent weight reduction that can be very hard to sustain,” he said. “It’s not your fault. Fat — adipose tissue — is hormonally active, and it fights back. That’s why it’s hard to lose weight.”

Other therapies, like GLP-1snbsp;and SGLT2 inhibitors, can help. If you pair these newer medications with lifestyle changes, it can lead to a 50 to 60 percent weight loss. 

“These medications mimic natural substances in your brain that switch off the desire to eat,” Dr. Bashall said. “This triggers pathways that promote insulin to work more efficiently and reduce inflammation.”

When the weight comes off, you have less pressure on your joints, your inflammation and pain decrease, and your cardiovascular health improves.  

Ways To Prevent Or Slow Down CKM Syndrome

If you reach stage 4 CKM, you can’t reverse the damage to your heart or other organs. But treatment can improve your symptoms and give you a better quality of life, Dr. Bashall said.

“Having stage 4 CKM isn’t hopeless. We can still treat you to prevent further progression and help you feel better,” he said. “A lot of the work we do is to prevent future health events and keep people as healthy as they can be.”

A good first step is to start medication, he said. But you can do several things on your own to reduce the impact CKM syndrome has on your life. You can:

• Avoid processed foods
• Choose a physical activity  you will do five or six times weekly. 
• Eat more lean protein and vegetables.
• Get recommended screening tests like heart scans or liver scans,
• Lift weights to build muscle that protects your joints and helps process insulin.
• Maintain good sleep habits.

When you adopt these behaviors early, you can help manage your existing CKM syndrome or reduce the risk you’ll develop the condition.

“You can prevent a lot of harm,” Dr. Bashall said. “We can’t stop your aging. But we can play interference on some of the harmful things that can happen as you age. This way, at 60 and beyond, you can still cycle, jog or be active.”

Frequently Asked Questions: CKM Syndrome

What are screening tests for CKM?

Regular health screenings that help you and your doctor understand if you are in earlier stages of CKM include:

• Blood pressure checks
• Blood sugar testing (glucose tests or A1C)
• Cholesterol/lipid panels
• Kidney function tests
• Weight and body measurements

Does CKM put me at risk of other health conditions?

CKM is linked to a higher risk of medical conditions including:

• Heart failure
• Heart attack
• Stroke
• Kidney disease
• Peripheral arterial disease
• Atrial fibrillation

Does CKM have symptoms?

Some people with CKM may not have symptoms right away. That’s why regular checkups with your doctor and health screenings are so important.

Can CKM develop in younger adults?

Yes, if you have high blood pressure, high cholesterol or are overweight, you are considered to be in the early stages of CKM, regardless of your age. Your risk of CKM does increase over time.

How can lifestyle changes help CKM?

Your heart, kidney and metabolic systems work together in your body. This is called cardiovascular-kidney-metabolic health. Lifestyle changes like walking, taking medication as prescribed, eating healthier, going to sleep at the same time each night, and practicing stress management can all contribute to better CKM health.