AHA Defines Cardiovascular-Kidney-Metabolic Syndrome, Redefines CVD Risk, Prevention, Management
In a move the American Heart Association hopes will increase early detection and treatment of potent risk factors responsible for the persistent increase in US cardiovascular morbidity and mortality, the professional organization has defined a constellation of cardiometabolic diseases as cardiovascular-kidney-metabolic, or CKM, syndrome.
Naming CKM, according to the AHA, acknowledges and identifies the strong connections among CVD, kidney disease, type 2 diabetes, and obesity. People who have or are at risk for CVD may have CKM syndrome and so be candidates for a range of interventions, including newer classes of pluripotent medications, with cardio- and renal-protective properties.
In a Presidential Advisory published in the journal Circulation, the AHA details a multifaceted paradigm that includes CKM staging, corresponding screening approaches and medications, a new approach to CVD risk estimation, and heightened emphasis on the impact of social determinants of health on disease risk and how to improve access, intervention, and outcomes.
The following slideshow offers a topline look at 10 highlights of the advisory as an introduction for primary care.
A definition of cardiovascular-kidney-metabolic syndrome from the American Heart Association
4-level staging construct proposed for cardiovascular-kidney-metabolic syndrome.
Screening for risk factors associated with CKM syndrome should be performed at all ages to optimize early intervention.
A new approach to CVD risk estimation includes additional factors (eg, age at menopause) assessing for ASCVD and HF, and initiating multimorbidity risk assessment as early as age 30 years.
Value- and volume-based interdisciplinary care for patients with multimorbidity can help reduce fragmentation of care and includes identifying a CKM team coordinator to manage patient flow and navigation across subspecialties.
The paradigm emphasizes the high burden of CKM syndrome in underserved populations and stresses incorporating SDOH into risk prediction and addressing SDOH as part of the clinical care model.
Excess or dysfunctional adiposity should be addressed through lifestyle modification and weight loss to prevent progression and to facilitate regression to earlier CKM stages.
Specific guidance is provided for timing of administration and patient selection for drugs with cardio- and renoprotective properties.
Chronic kidney disease should be monitored regularly in patients with CKD, diabetes, HTN, and MetS and renoprotective therapies initiated in a timely manner.
The AHA advisory outlines a framework to optimize CKM health at the population level, including investing in research related to CKM syndrome and systematically assessing and addressing SDOH.
The AHA framework to optimize US CKM health also includes increasing equitable access to pharmacotherapies and supporting value- and volume-based interdisciplinary care models.
Source: Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148:00-00. doi: 10.1161/CIR.0000000000001184
