The New Syndrome That Affects the Heart, Kidneys & Lungs

You might think of heart disease, kidney disease, diabetes and obesity as separate health problems, but they’re closely connected. Together they make up what’s now called cardiovascular-kidney-metabolic (CKM) syndrome.

CKM syndrome doesn’t only affect older adults. It’s increasingly affecting young adults too, and many don’t realize it. “The biggest risk factor is obesity, and it’s on the rise in the U.S.,” says Ian Neeland, MD, Director of Cardiovascular Prevention at University Hospitals Harrington Heart & Vascular Institute.

What Is CKM Syndrome?

CKM syndrome isn’t just one condition. “It’s a name for a group of interconnected risk factors and conditions that impact the heart, kidneys and metabolism,” says Dr. Neeland. Because these organ systems are so intertwined, a problem in one can affect the others. “Over time, this can raise the risk of serious complications, like heart attack, heart failure, kidney failure or even death.”

CKM risk factors include:

• Excess body fat
• High blood pressure
• Abnormal lipids (cholesterol and triglycerides)
• Reduced kidney function (chronic kidney disease and kidney failure)
• High blood sugar (pre-diabetes or diabetes)
• Heart disease, atrial fibrillation, heart failure or stroke

It’s common to have more than one of these risk factors at the same time, but it’s not always obvious how they affect each other or make health problems worse. For example, being overweight can make it harder for your body to regulate blood sugar. If that leads to diabetes, it puts stress on your blood vessels, which can damage your kidneys, heart and other organs.

“The best way to care for these conditions and keep them from getting worse is to manage them together in a holistic way, rather than treating each one separately,” says Dr. Neeland.

Stages of CKM Syndrome

CKM syndrome is organized into stages, from lowest to highest risk. Your healthcare provider will determine your stage based on your risk factors and overall health.

The stages of CKM syndrome are:

• Stage 0: You don’t have CKM
• Stage 1: Extra body fat with no other risk factors
• Stage 2: Multiple risk factors (such as high blood pressure, high cholesterol, diabetes, kidney disease or metabolic syndrome)
• Stage 3: Early heart disease without symptoms
• Stage 4: Multiple conditions and heart disease with symptoms.

“About 90% of people in the U.S. have at least stage 1 CKM syndrome, and the majority of them have stage 2,” says Dr. Neeland. He explains that at stage 1 you can progress to stage 2 and beyond, but you can also return to stage 0 by achieving a healthier weight.

At stage 2, you can address your weight and other risk factors, and then return to stage 1 or 0. “Once you get to stage 3 or 4, you can't go back,” he says. “At that point, it’s no longer about managing symptoms and reducing the risk of progression, it’s about intervention and disease treatment.”

Why Are So Many Young Adults at Risk for CKM Syndrome?

A recent study by the American Heart Association (AHA) found that nearly 80% of participants, who were around the age of 23, had CKM syndrome stage 1, 2 or 3.

Obesity is one of the main causes of the syndrome, and it has been increasing in both adults and children in recent years. The percentage of people with obesity in the U.S. rose from 30% in 1999 to 41% in 2023. Obesity in youth under 20 also increased significantly, rising about 30% compared with 1999 levels.

“The obesity epidemic is the main reason rates of CKM syndrome are rising among young adults,” says Dr. Neeland. For many, CKM syndrome starts in adolescence or early adulthood. It can develop slowly and silently. “That’s why it’s extremely important to get screened for risk factors and to intervene with treatment before the stages progress.”

How Is CKM Syndrome Diagnosed?

Getting regular screenings can help with early detection. “Screenings are an important first step toward making a diagnosis and assessing what stage you’re in,” says Dr. Neeland.

Screenings used to assess your CKM risk may include:

• Blood pressure check
• Blood sugar test (glucose or A1C blood test)
• Lipid panel (cholesterol and triglycerides blood test)
• Kidney function tests (eGFR blood and UACR urine tests)
• Weight and waist measurements (BMI)
• A review of your health history and lifestyle habits, as well as your family health history

In some cases, further testing may also be needed. “Once you have a stage, then appropriate interventions can be recommended to help slow the progression,” he says.

Managing Your Health With CKM Syndrome

Treatment for CKM syndrome varies, depending on what stage you’re in and what conditions you have. You may work with one or more healthcare providers to create a personalized treatment plan.

For stage 1, lifestyle changes like eating healthier, getting more physical activity, improving sleep, managing stress and avoiding tobacco may be enough. For some people, a medication may also be recommended to help manage weight.

“At higher stages, treatment usually becomes more involved, combining lifestyle changes with medical care,” says Dr. Neeland. This might include diet and exercise modifications, medications such as GLP-1s and others that have multiple effects on several components of CKM syndrome and procedures like stent placement, heart surgery or kidney dialysis.

To help manage CKM syndrome, your primary care doctor may refer you to other healthcare providers, such as a heart, kidney or metabolic health specialist, diabetes educator, dietitian or health coach. “Multi-disciplinary care is key,” says Dr. Neeland. “Coordinating care across specialties is needed to improve outcomes, which is exactly what we do in our CINEMA program.”

How to Protect CKM Health

“The best way to prevent CKM syndrome is to start with healthy habits early in life,” says Dr. Neeland. A healthy lifestyle doesn’t just protect your cardiovascular, kidney and metabolic health — it benefits your overall well-being.

Even if you already have CKM syndrome, making lifestyle modifications and behavior changes can help.

Dr. Neeland recommends aiming to:

• Eat well-balanced meals and snacks
• Move more, doing both aerobic and strength-training activities
• Get 7 to 9 hours of quality sleep
• Avoid tobacco products
• Work toward a healthy weight
• Reduce stress as much as possible
• Manage cholesterol, blood sugar and blood pressure, as necessary

Your healthcare team can help you figure out which changes make the most sense for you and where to start.

Related Links

The experts at UH Harrington Heart & Vascular Institute and the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) take a comprehensive approach to developing personalized treatment plans that lower cholesterol, reduce cardiovascular risk, manage cardiometabolic health and support weight loss goals.