Science and clinical management of cardiovascular–kidney–metabolic syndrome

A major determinant of premature morbidity and mortality is poor cardiovascular, kidney and metabolic health. The development of strategies to improve health in these areas has, therefore, become a key health priority.

A growing understanding of the interrelatedness of metabolic, kidney and cardiovascular risk factors has led the American Heart Association (AHA) to offer a consensus definition of a previously under-appreciated disorder. Cardiovascular–kidney–metabolic (CKM) syndrome is characterised by pathophysiological interactions among metabolic risk factors (including type 2 diabetes and obesity), chronic kidney disease (CKD) and the cardiovascular system. It leads to multi-organ dysfunction and adverse cardiovascular and kidney outcomes that go beyond the sum of its components. 

Based on an analysis of current guidelines and research literature, the present scientific statement from the AHA provides a synopsis of the evidence on these interactions and how they affect health. It sets out approaches to the prevention and management of CKM syndrome at each stage of its development (including those with established cardiovascular disease and coexisting metabolic risk factors, CKD, or both), and the evidence supporting them. The importance of interdisciplinary care and of screening for social need are emphasised.

The statement highlights critical knowledge gaps related to CKM syndrome regarding the mechanisms of disease development, phenotypic heterogeneity, interplay between social determinants of health and biological risk factors, and accurate assessments of risk of adverse CKM outcomes in the context of competing risks. 

It also points to limitations in the evidence supporting the clinical care for CKM syndrome. These relate to prevention in early life, screening for risk factors, the targeting of emerging cardio- and kidney-protective therapies, and the management of people with both cardiovascular disease and CKD. 

The statement concludes by charting a path for science and clinical care in relation to CKM syndrome, which it believes can help people live longer and healthier lives.

The full statement can be read here.