- American Heart Association officials say kidney disease is part of a constellation of chronic health conditions that include cardiovascular disease, type 2 diabetes, and obesity.
- They have presented a newly defined cardiovascular-kidney-metabolic (CKM) syndrome that adds kidney disease to the connection.
- Experts say the CKM definition can improve prevention, intervention, and treatment through more integrated care.
Cardiovascular disease, type 2 diabetes, and obesity have long been linked through research and in disease prevention and treatment protocols.
The American Heart Association says that another chronic health problem, kidney disease, should also be included.
In a presidential advisory issued in the journal Circulation, the association for the first time defined cardiovascular-kidney-metabolic (CKM) syndrome and called on the healthcare community to integrate care for the related diseases.
“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.”
“Cardiovascular disease, obesity, diabetes, and kidney disease have shared risk factors and can each contribute to the development and progression of each other,” Dr. Dmitry Abramov, a cardiologist at Loma Linda University International Heart Institute in California, told Medical News Today. “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.”
What to know about new cardiovascular-kidney condition
According to the American Heart Association’s 2023 Statistical Update, one in three U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders, and/or kidney disease.
“CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver,” according to the association. ”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:
- Stage 1: Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or pre-diabetes.
- Stage 2: Metabolic risk factors (includes people with type 2 diabetes, high blood pressure, high triglycerides) and kidney disease.
- Stage 3: Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease.
- Stage 4: Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease.
“This classification helps both physicians and patients understand their risks for developing cardiac risk factors like obesity, diabetes, hypertension and heart failure,” Dr. Majid Basit, a cardiologist with Memorial Hermann Health System in Houston, told Medical News Today. “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,” Basit added. “Defining a patient’s stage helps the physician and the patient identify disease risk and the therapies indicated for that particular stage.”
“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,” Ndumele said.
Prevention, intervention, and treatment for CKM syndrome
A fragmented treatment system, however, means that doctors may not be aware of these therapies or treat CKM holistically.
“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,” said Abramov.
“The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient,” 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.”
“Physicians, including primary care doctors, diabetes specialists, kidney specialists, and cardiologists are all involved in the care of CKM patients,” said Basil, who noted that intervention can start in childhood. “Pediatricians can help identify patients at risk at an early age,” he said. “The obesity pandemic along with a sedentary lifestyle has led to patients with CKM syndrome well before adulthood.”
“Multidisciplinary care is key because patients with obesity, diabetes, and kidney disease often see a large number of clinicians,” added Abramov. “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 American Heart Association also called for updating the standard assessment tool known for atherosclerosis cardiovascular risk, known as the Pooled Cohort Equation.
They recommended the update include measures of kidney function, type 2 diabetes control (using blood test results instead of a yes/no response), and social determinants of health.
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