Newly-defined heart syndrome could affect 30% of Americans

The American Heart Association (AHA) has released an advisory warning about a newly-recognised condition called cardiovascular-kidney-metabolic (CKM) syndrome.

Defining CKM syndrome marks the first time experts have acknowledged an overlap in symptoms caused by kidney disease, type 2 diabetes, and obesity—and how these illnesses may influence the risk of cardiovascular disease—according to a statement from the AHA.

“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” Dr Chiadi E Ndumele, associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University, said in the 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.”

CKM syndrome symptoms range in severity, and they’ve been mapped on a scale that spans five stages.

People at stage 0 have no risk factors for the disease. At this stage, the focus is merely preventative, and the goal is to make sure the patient doesn’t develop CKM syndrome in the future.

Patients who fall in the “stage 1” category have excess body fat or an “unhealthy distribution of fat”, which may include abdominal obesity, prediabetes, or impaired glucose tolerance. People who fall into this category should opt for healthy lifestyle changes and, potentially, try to lose five per cent of their total body weight.

People who have stage 2 CKM syndrome have kidney disease and metabolic risk factors. This includes people with high blood pressure, type 2 diabetes, kidney disease, or high triglycerides; people in this group are also at an increased risk for worsening kidney and heart disease.

“The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure,” per the AHA. Treatment at this phase could include medications that help control blood pressure, cholesterol, or blood sugar.

Those who have stage 3 CKM syndrome have early cardiovascular disease that isn’t yet causing symptoms as well as kidney disease or metabolic risk factors. The treatment for people in this category should focus on preventing the patient’s symptoms from progressing. Implementing lifestyle changes may be helpful for people with stage 3 CKM, as can increasing or adjusting a person’s medications.

People with the most advanced CKM syndrome, stage 4, are already exhibiting symptoms of cardiovascular disease. People in this category have excess body fat and kidney disease or metabolic risk factors. There are two subcategories for stage 4 CKM. People with stage 4a do not have kidney failure while people with stage 4b do.

CKM syndrome is likely very common in the US: According to the AHA, as much as one-third of Americans could have the condition, which affects “nearly every major organ in the body, including the heart, brain, kidney, and liver”.

The new advisory from the AHA could help physicians spot and treat the syndrome before it progresses, Dr. Ndumele said in the statement. This may require doctors who have different specialities to coordinate. “The advisory suggests ways that professionals from different specialities can better work together as part of one unified team to treat the whole patient,” he said.

“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.”