In response to a growing trend of younger Americans being diagnosed with multiple chronic health conditions, the American Heart Association has taken the unprecedented step of acknowledging a novel medical condition that underscores the strong connections between obesity, diabetes, and heart and kidney diseases.
An advisory released on Monday introduces this new condition as “cardiovascular-kidney-metabolic syndrome,” or CKM, with the primary aim of facilitating early diagnosis and treatment for individuals at high risk of succumbing to cardiovascular disease.
Dr. Chiadi E. Ndumele, the director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University and the lead author of the advisory, stated, “Reducing the pipeline of individuals progressing to heart disease is our primary goal.” He emphasized that the current healthcare landscape demonstrates the adverse consequences of the interactions between these various conditions, leading to earlier onset heart disease. The introduction of CKM represents a significant shift in medical paradigms.
Emerging evidence underscores how metabolic risk factors, such as abdominal fat, high blood pressure, high cholesterol, and elevated blood sugar levels, can detrimentally impact various organs in the body. Dr. Pam R. Taub, a cardiologist and professor of medicine at the UC San Diego School of Medicine, noted that this new approach could be a “game changer” in patient care, as it allows doctors to view the interplay between organs within the body.
One notable example is the early detection of kidney disease through urine samples. Prompt intervention with appropriate medications can prevent its progression to chronic kidney disease.
When assessing the body’s organs collectively, early detection of diseases becomes feasible, leading to the prevention of adverse cardiovascular outcomes such as heart failure, heart attacks, and stroke.
Fortunately, individuals with CKM can improve their condition if it is identified early and addressed through lifestyle changes and weight loss.
The advisory also outlines a stage-based system for physicians to identify patients at risk:
- Stage 0: No risk factors for heart disease.
- Stage 1: Overweight individuals with significant abdominal fat or prediabetes. Lifestyle changes and a 5% weight loss goal are recommended.
- Stage 2: Individuals with Type 2 diabetes, high blood pressure, high triglycerides, or kidney disease. Treatment options may include medications for blood pressure, blood sugar, and cholesterol, as well as diabetes drugs like SGLT2 inhibitors and GLP-1 receptor agonists.
- Stage 3: People with metabolic risk factors, early cardiovascular or kidney disease without symptoms. Treatment may involve heart and diabetes medications and artery narrowing assessments.
- Stage 4: Those with diagnosed heart disease, excess body fat, metabolic risk factors, or kidney disease. Patients may have experienced heart attacks, strokes, or heart failure, and they may or may not have kidney failure.
It’s estimated that more than 90% of adults fall within the CKM spectrum due to rising levels of obesity and Type 2 diabetes in both adults and children. Statistics from the Centers for Disease Control and Prevention indicate that 41.9% of adults and 19.7% of children in the U.S. are obese, with over 37 million adults having diabetes.
This advisory could encourage physicians to broaden their focus and identify and treat patients before conditions progress. It may also raise awareness among patients about the health risks associated with obesity.
Dr. Howard Weintraub, the clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart in New York, expressed concerns about the cost of new drugs and potential reluctance from insurance companies, particularly for those in the early stages of CKM.
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Ultimately, the most effective approach is to promote healthy habits among young Americans to prevent the development of these conditions in the first place. As Weintraub highlighted, “We need to keep America’s youth a healthy weight and not let their arteries turn into lead pipes by the time they are in their 30s.”