The American Heart Association (AHA) has developed a brand new strategy for the prevention and management of cardiovascular disease (CVD).
This updated approach highlights the close relationship CVD has with three other significant health conditions: kidney disease, type 2 diabetes (T2D) and obesity. Patients with CVD, for example, often face a heightened risk of developing kidney disease, T2D or obesity. The opposite can also be true—patients with any of those three conditions may face a heightened risk of developing CVD.
With these close connections in mind, the AHA has defined a new health condition: cardiovascular-kidney-metabolic (CKM) syndrome. CKM syndrome involves nearly every major organ in the body, the group said in a new statement, though its biggest impact is on a patient’s cardiovascular system.
Anyone who has CVD, or even faces a risk of developing CVD in the future, may have CKM syndrome. By educating physicians and patients alike on the way these different conditions interact with one another and implementing a screening strategy for CKM syndrome, the AHA believes it can help patients get the care they need to live longer, healthier lives.
“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,” Chiadi E. Ndumele, MD, PhD, writing committee chair and director of obesity and cardiometabolic research in the cardiology division at Johns Hopkins University in Baltimore, said in the AHA’s statement.
The AHA has published a presidential advisory that examines CKM syndrome at length, detailing recommendations related to the screening, identification and management of this newly defined condition.
“We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care 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.”
Learning the stages of cardiovascular-kidney-metabolic syndrome
One of the key takeaways from the document is the various stages of CKM syndrome.
Stage 0: These are patients presenting with no risk factors related to CKM syndrome. The AHA recommends that even these individuals should be screened every three to five years by evaluating their blood pressure, triglycerides, HDL cholesterol and blood sugar. They should also be encouraged to maintain a healthy lifestyle, which means eating a balanced diet, remaining physically active, etc.
Stage 1: These are patients with “excess body fat and/or an unhealthy distribution of body fat.” The AHA recommends screening these individuals every two to three years. A goal of at least 5% weight loss should be established.
Stage 2: These are patients presenting with metabolic risk factors and kidney disease. They may already have TD2 or high blood pressure, for example, and medications may need to be prescribed if that has not already occurred. Yearly assessments are recommended, and “more frequent kidney screening” may be necessary for any person who faces a heightened risk of kidney failure.
Stage 3: These are patients with metabolic risk factors and/or kidney disease who are in the early stages of CVD. CVD may be asymptomatic for individuals in this group. Coronary artery calcium screening is recommended. If healthcare providers identify signs of heart failure, therapy should be “intensified” as needed to prevent symptoms from continuing to develop. Disease regression is still possible at this stage. It can potentially be achieved if patients follow healthier lifestyles and take all medications as recommended.
Stage 4: These are patients who have symptomatic CVD in addition to excess body fat, various metabolic risk factors and/or kidney disease. Anyone in this category may have already experienced a myocardial infarction or stroke, or they may already present with heart failure, peripheral artery disease or atrial fibrillation. They need individualized treatment.
Predicting a patient’s risk of cardiovascular-kidney-metabolic syndrome
The AHA wrote that the existing risk calculator for atherosclerotic CVD, the Pooled Cohort Equation, should be updated to include measures of kidney function, T2D and various social determinants of health.
“Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate,” according to the group. “The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome.”
AHA call to action on CKM
“There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele 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.”
The AHA specifically called for investing in more research to help specialists better understand the way these different conditions interact.
Resources from the American Heart Association
Click here to read the full presidential advisory in Circulation. The AHA provided additional information about CKM syndrome in a separate scientific statement, which was also published in Circulation.