Margarett Shnorhavorian, MD, MPH
On Call With Dr. Kumar: Cardiovascular Kidney Metabolic Syndrome, Or CKM, Explained
On Call with Dr. Kumar: Cardiovascular Kidney Metabolic syndrome explained
On Call with Dr. Kumar: Cardiovascular Kidney Metabolic syndrome explained 03:26NEW YORK -- The American Heart Association has identified a new medical condition, called Cardiovascular Kidney Metabolic syndrome, or CKM.
They discovered a link between four key factors: Cardiovascular disease, kidney disease, type 2 diabetes, and obesity.
Dr. Nidhi Kumar is On Call for CBS New York to help understand what this is and how it could impact you.
"Just to put in perspective, 33% of Americans have three or more risk factors that contribute to this syndrome. And when we think of danger in medicine, sometimes people think of the words 'cancer' or 'COVID,' but chronic diseases, like those that make up CKM, are the leading cause of death and disability in the United States," she said.
She explained how dangerous the syndrome can be and how to calculate your risk. We also talked about its stages and prevention.
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New Syndrome Identified That Links Heart Disease, Metabolic Disorders, And Kidney Disease
Heart disease has long been linked to other chronic conditions including diabetes and kidney disease. It is the top cause of death for both men and women in the U.S. And 1 in 3 adults have three or more risk factors that contribute to heart disease, metabolic disorders and kidney disease, according to the American Heart Association.
Now, officials from the American Heart Association (AHA) say in some cases, these connected conditions can be defined as a new syndrome called cardiovascular-kidney-metabolic syndrome or CKM.
Health experts have long noted connections between cardiovascular disease among obesity, type 2 diabetes, and chronic kidney disease.
AHA officials published the advisory in the journal Circulation to help redefine cardiovascular disease risk, prevention and management.
"The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome," said Dr. Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, co-author and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore said in a statement. "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."
The AHA has released a presidential advisory in the hopes that healthcare providers can help people more effectively treat CKM.
The advisory includes information about the stages of the disease and potential causes.
The advisory includes:
Additionally, the AHA recommends physicians review the risk calculator for heart attack and stroke that can help predict who is most at risk for these cardiac events. They propose the new algorithm offer heart attack and stroke estimates at the 10 year and 30 year mark.
One reason the AHA is releasing this advisory is in the hopes that more people can get access to better treatment.
"This advisory is very timely and includes important changes to incorporate a new model where we think more about the risk factors," Dr. Dennis Bruemmer, doctor of cardiovascular medicine at the Cleveland Clinic, told Healthline. "The guidelines have shifted to a more preventative care approach which I think is important. It's steering away from being a reactive model system to a more proactive system where we look at individual risk factors and how to treat risk factors earlier which ultimately will prevent complex diseases."
Bruemmer was not part of the advisory committee.
When screening for and addressing social factors that impact health and CKM risk, physicians can consider issues such as economic stability, access to health care, and education level.
"These are very important for us to consider when we treat patients," said Bruemmer. "For example, when we encounter a patient who has diabetes, we have to put this into the overall context in the life of the patient – economics, insurance, environmental factors and so on. All of these social determinants affect the care that we provide."
Dr. Rohan Khera, Director of the Cardiovascular Data Science (CarDS) Lab at Yale School of Medicine explained that this advisory reflects the reality of clinical practice.
"Physicians have been aware that things don't live in isolation, and a lot of our cardiovascular risk factors can be concurrent with metabolic risk factors and kidney risk factors," said Khera. "So people who have cardiovascular disease frequently have metabolic challenges and chronic kidney disease."
Khera continued: "From our perspective, we've always recognized that those things tracked together, and therefore we needed to think about these patients in a more holistic fashion. But it's never been reflected in our clinical guidelines."
Khera agreed social factors play a major role.
"We've recognized over the past several decades that poverty, lack of access to education, health literacy – these social determinants of health that pervade diet and lifestyle decisions – can cause people to be at high risk compared to others of the same age and sex," Khera stated. "And we know that underrepresented racial and ethnic groups bear an excessive burden from these social determinants of health, which contributes to worse heart- and kidney-related outcomes."
Another main focus of the advisory is ensuring that physicians are in contact across specialties so a cardiologist will talk to nephrologist or a physician who specializes in kidney care. To help person with CKM multiple physicians may be needed including a primary care physician, cardiologist and endocrinologist, all bringing their expertise to the table.
"Collaborative care means that we recognize the importance of working within a system of specialists," Bruemmer stated. "Now, we have evidence from clinical studies that have studied collaborative care approaches and have seen that it is effective when doctors work together to manage these risk factors."
Looking at these diseases from a holistic perspective is crucial.
"It's predominantly about making sure there is collaboration across community health, primary care and specialty care providers," said Khera. "The theme I'm seeing emerge is that we need to think of these diseases, and their risk drivers, in a more holistic way. Redefining the way we think about disease management by taking social factors into account."
Understanding risk is important to develop an effective treatment plan for people with these conditions.
"When we sit with a patient in the office and talk about the future of their health, we don't have a crystal ball but we like to assess the risk," said Breummer. "If a person has a higher risk we can implement more aggressive preventive care strategies that will lower the future risk for heart attack, stroke, and diabetes. It is important to convey this to the patient because if they know their risk if higher they are likely going to be more motivated to change."
Khera explained patients should be asking whether they have features or markers that actually put them at a higher risk in the future.
"We've done a lot of assessments of risk factors over the years and over the last 5 to 8 years, we've seen a move toward more quantitative ways of describing risk," Khera stated. "Not just a particular risk factor, or saying you're high-risk or low-risk, but combining risk factors to compute someone's actual risk for developing a disease over the next five years. That information can help develop personalized lifestyle and treatment plans to manage that risk."
If you're concerned you have signs of heart, kidney or metabolic disease, you can talk to your physician about risk factors.
According to Breumer, top four indicators of health can include:
Officials from the American Heart Association say that multiple chronic conditions can be defined as a new syndrome called cardiovascular-kidney-metabolic syndrome or CKM.
The advisory noted a connection between cardiovascular disease, obesity, Type 2 diabetes and chronic kidney disease, known as cardiovascular-kidney-metabolic (CKM) syndrome.
Revised recommendations for screening, stages and treatment are included.
Health experts confirm a collaborative model ensures optimal patient care.
New Cardiovascular-kidney-metabolic Syndrome Linked To Obesity And Diabetes
Cardiovascular disease, type 2 diabetes, and obesity have long been linked through research, disease prevention, and treatment protocols.
The American Heart Association (AHA) has identified another chronic health problem and says that kidney disease should also be included.
For the first time, the AHA defined cardiovascular-kidney-metabolic (CKM) syndrome and called on the healthcare community to integrate care for the related diseases. The statement was issued in a presidential advisory published in the journal Circulation,
"The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome," said Dr. Chiadi Ndumele, the 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, in a press statement.
"Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively."
According to the AHA's 2023 Statistical Update, 1 in 3 adults in the United States have three or more risk factors contributing to chronic conditions such as:
"CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver," according to the AHA.
"However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more."
The advisory outlined four stages of CKM along with prevention and treatment protocols:
"The advisory provides guidance for healthcare professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome," Dr. Ndumele stated.
Dr. Majid Basit, a cardiologist with Memorial Hermann Health System in Houston, not involved in the study told Medical News Today:
"This classification helps both physicians and patients understand their risks for developing cardiac risk factors like obesity, diabetes, hypertension and heart failure. These diseases are all linked together, and having one increases your risk of developing the others. Although the classification of CKM syndrome is new, the underlying concept is well understood by physicians. Defining a patient's stage helps the physician and the patient identify disease risk and the therapies indicated for that particular stage."
A fragmented treatment system means doctors may not know the therapies for CKM or understand how to treat the disorder holistically.
"The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient," Dr. Ndumele said.
"There is a need for fundamental changes in how we educate healthcare professionals and the public, how we organize care and how we reimburse care related to CKM syndrome. 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," Dr. Ndumele continued.
Dr. Dmitry Abramov, a cardiologist at Loma Linda University International Heart Institute in California, told MNT:
"Cardiovascular disease, obesity, diabetes, and kidney disease have shared risk factors and can each contribute to the development and progression of each other. Targeting kidney disease adds an extra pathway to reduce not only the progression of kidney disease itself, often saving patients from the difficulties of dialysis, but also to reduce progression of cardiovascular disease and other associated conditions.
Clinicians and patients have an increasingly large number of tools to improve their cardiovascular health, and this advisory is a key step in increasing physician and public awareness of the multiple treatments that are available but underutilized today."
Dr. Basit noted that healthcare professionals such as physicians, primary care doctors, diabetes specialists, kidney specialists, and cardiologists can all be involved in the care of CKM patients. He pointed out that intervention could start during childhood.
"Pediatricians can help identify patients at risk at an early age," Dr. Basit said. "The obesity pandemic along with a sedentary lifestyle has led to patients with CKM syndrome well before adulthood."
Dr. Abramov added that multidisciplinary care is crucial.
"Patients with obesity, diabetes, and kidney disease often see a large number of clinicians," Dr. Abramov said. "Collaboration between the treatment team on a shared message and treatment plan will add expertise to optimize medical care and will help empower patients to better understand the multiple treatment options available."
The AHA also called for updating the standard assessment tool known for atherosclerosis cardiovascular risk, known as the Pooled Cohort Equation.
They recommended the update include:
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