9 in 10 US Adults May Already Be in Early Stages of This Heart-Kidney-Metabolic Syndrome, Experts Say

Nearly 90% of American adults may already be somewhere on the spectrum of a newly formalized health condition that links heart disease, kidney function and metabolic health, according to guidance released this year by the American Heart Association and several partner medical organizations. Doctors say growing recognition of the connection is changing how they screen for and treat some of the country’s leading causes of death.

A newly named, but long-suspected, connection

The condition, known as cardiovascular-kidney-metabolic syndrome, or CKM syndrome, describes how dysfunction in the heart, kidneys and metabolic system are interconnected rather than separate, unrelated health issues. For years, doctors treated conditions like heart disease, diabetes, obesity and kidney disease largely in isolation. That’s beginning to change, according to Dr. Andrew Pogozelski, a cardiologist with Allegheny Health Network, who said physicians increasingly recognize how tightly these systems are linked, even before serious symptoms appear.

The American Heart Association first introduced the concept of CKM syndrome roughly three years ago through a presidential advisory. This June, the AHA, the American College of Cardiology, the American Diabetes Association and the American Society of Nephrology jointly released the first-ever clinical practice guideline specifically addressing CKM syndrome, published simultaneously in the medical journals Circulation and the Journal of the American College of Cardiology. The guideline replaces and expands upon the AHA’s 2013 guidance on managing overweight and obesity in adults, reflecting how significantly the medical understanding of these interconnected conditions has evolved.

Nearly universal risk, according to new data

According to the new guideline, nearly 90% of U.S. adults have at least one CKM syndrome risk factor, which can include excess weight, high blood pressure, abnormal cholesterol or lipid levels, elevated blood sugar, or reduced kidney function. Obesity alone affects roughly 40% of American adults and 21% of children and adolescents, according to the guideline’s authors, underscoring how broadly these risk factors already extend across the population.

Pogozelski said one of the earliest and most telling warning signs tends to be visible well before a formal diagnosis. “Especially obesity kind of in the midsection where your waistline is increasing over time” is often the first indication someone may be heading down the CKM syndrome spectrum, he said, describing central weight gain as one of the clearest early markers physicians look for.

Four stages, from risk to disease

The guideline organizes CKM syndrome into four stages, beginning with Stage 1, which includes people who are overweight, obese or prediabetic but don’t yet have other metabolic risk factors, kidney disease or cardiovascular disease. Stage 2 includes people with one or more additional metabolic risk factors, such as high blood pressure, abnormal lipid levels, Type 2 diabetes or metabolic syndrome, and may include early kidney disease, still without diagnosed cardiovascular disease. Stage 3 applies to people with subclinical, or asymptomatic, cardiovascular disease combined with CKM risk factors, or those considered at very high risk for cardiovascular events or advanced kidney disease based on updated risk calculations. Stage 4 represents the most advanced stage, encompassing people already diagnosed with cardiovascular disease, such as coronary heart disease, heart failure, stroke, peripheral artery disease or atrial fibrillation, layered on top of obesity, other metabolic risk factors or kidney disease.

Pogozelski said the staging system is designed to capture people early, even when they have no outward symptoms. Risk factors, he explained, can build silently over years before eventually contributing to a heart attack, stroke or kidney failure, making early identification particularly valuable.

Higher stakes in western Pennsylvania

The condition carries particular relevance in western Pennsylvania, where mortality rates from heart disease in several counties already exceed national averages. Local doctors say the region’s elevated heart disease burden makes early screening for CKM risk factors especially important, given how closely those risk factors are now understood to be tied to kidney and metabolic health outcomes as well.

New tools for prevention and treatment

Beyond identifying and staging risk, the guideline introduces updated tools intended to help doctors act on that information more precisely. Chief among them are new risk calculations known as the PREVENT equations, which estimate a person’s 10- and 30-year risk of cardiovascular disease while factoring in kidney and metabolic health measures, offering a more comprehensive risk picture than previous tools that focused on cardiovascular risk alone. The guideline also recommends screening for social factors that can affect health outcomes, including food insecurity, housing instability and financial strain, reflecting a broader push to address the practical barriers that can prevent people from managing these interconnected conditions effectively.

On the treatment side, the guideline highlights a mix of lifestyle changes and newer medications. Pogozelski said that outside of medication, the most effective intervention remains straightforward. “The biggest thing you could do, short of medications, would be weight loss, exercise, eating a diet that’s kind of low in sugar, low in simple carbohydrates, more high in proteins and good fats, like a Mediterranean diet,” he said, describing the foundation of lifestyle-based prevention for people at any stage of the CKM spectrum.

Medications originally designed for diabetes gaining a broader role

The guideline also points to a shift in how certain medications are being used. Drug classes originally developed to manage diabetes, including GLP-1-based therapies and SGLT2 inhibitors, have shown benefits that extend beyond blood sugar control, improving cardiovascular outcomes and slowing kidney disease progression in some patients. That expanded role has pushed doctors across specialties to coordinate more closely when treating patients who may be managing multiple interconnected conditions simultaneously.

Fátima Rodriguez, an associate professor of cardiovascular medicine at Stanford Medicine and vice chair of the guideline’s writing committee, said the recommendations are built around a broader framework the AHA calls Life’s Essential 8, which includes regular physical activity, heart-healthy eating, maintaining a healthy weight, and managing blood pressure, blood sugar and cholesterol, along with avoiding tobacco and getting adequate sleep. “These actions reduce the risk of heart disease and also support kidney and metabolic health across the lifespan,” Rodriguez said.

What it means for patients

Because CKM syndrome staging begins well before a person develops diagnosed disease, doctors say the guideline is designed to give patients and physicians a shared framework for catching risk factors early and intervening before conditions progress to heart attacks, strokes or kidney failure. With risk factors so widespread across the adult population, physicians say routine screening, honest conversations about weight and lifestyle, and closer coordination between specialists are likely to become a more standard part of preventive care in the years ahead.