Susan Gilchrist, a preventive cardiologist and epidemiologist sees patients all the time at the University of North Carolina Cardiovascular-Kidney-Metabolic (CKM) Syndrome Clinic who don’t know what CKM is and are not sure why they’re in her clinic.
It’s not surprising — CKM syndrome was only recently coined, in 2023, by the American Heart Association (AHA). And roughly 9 in 10 U.S. adults — about the same number of people estimated to have it — have never heard of it.
CKM syndrome is not one disease but rather “a broad disorder that recognizes the overlap between cardiovascular, kidney and metabolic conditions such as diabetes and obesity,” said Muthiah Vaduganathan, a cardiologist at Brigham and Women’s Hospital who has conducted landmark studies on CKM syndrome. Doctors have long known that people often have more than one of these conditions at once. CKM syndrome reflects a newer understanding that the very same factors — specifically, extra weight, high blood pressure, high blood sugar, abnormal cholesterol and reduced kidney function — can contribute to the onset and progression of all three types of disease, Vaduganathan said.
The good news is that a similar set of therapies can be used to manage conditions across the CKM triangle, Vaduganathan said.
How does CKM syndrome start and progress?
Researchers have defined CKM syndrome as a four-stage continuum, reflecting how symptoms and risk factors progressively pile up, raising the likelihood of a heart event or kidney failure.
- Stage 1: Includes people with extra fat tissue — defined as a body mass index (BMI) of 25 or higher, or a waist circumference of 88 centimeters or greater in women and 102 centimeters or greater in men — and those with “dysfunctional” fat tissue, who may not have a larger body but show signs of poor glucose tolerance, like prediabetes. Because BMI can’t distinguish lean body mass from fat, it can misclassify short or muscular people as overweight, which is why Gilchrist said experts often use it in tandem with the other metrics here to pinpoint those who fall in this risk bucket.
- Stage 2: Includes people with metabolic risk factors that often flow from extra fat tissue, like high blood levels of a type of fat called triglycerides, high blood pressure, metabolic syndrome (a cluster of symptoms that can include either of the previous two, as well as a large waist, poor cholesterol and high blood sugar), diabetes or chronic kidney disease. At this stage, people still tend to be asymptomatic, Vaduganathan said. Getting categorized requires bloodwork, usually done at a routine physical.
- Stage 3: Includes those from prior stages who’ve developed presymptomatic heart disease, such as atherosclerosis or heart failure, and those with very high-risk CKD or a risk greater than 20 percent of a heart event in the next 10 years, based on the AHA’s PREVENT calculator. Since the disease might still be silent at this point, a person would be classified when their doctor orders screenings based on the above risk factors.
- Stage 4: Includes people from the above stages who’ve been diagnosed with a stroke, heart failure, coronary heart disease, peripheral artery disease or atrial fibrillation. This stage, which can occur with kidney disease (stage 4b) or without (stage 4a), covers the most severe outcomes of CKM syndrome and brings a high risk of future heart events, too.
This framework has helped Gilchrist explain to patients why weight matters for health: Carrying extra weight alone does not equate to disease — but it may put you on a path toward it. A large waist circumference and high blood sugar, in particular, are signs of what Gilchrist called “metabolically dangerous” fat. It releases inflammatory proteins into the blood and can rev up your body’s “fight or flight” stress state, she said.
That combination can raise blood pressure and levels of certain fats in the blood, and make cells resistant to insulin (which helps with sugar uptake), dumping even more sugar in the blood. Both high blood sugar and high blood pressure can damage the tiny blood vessels feeding the kidneys, harming their ability to filter waste and extra fluid, said Joshua Joseph, an endocrinologist at the Ohio State University Wexner Medical Center. The fluid backup increases blood volume, straining the heart and further raising blood pressure, Joseph said, setting off a downward spiral toward heart events and kidney failure.
Why is CKM syndrome becoming a more common diagnosis?
The CKM framework was only formalized in 2023, and the physician guidelines for identifying and managing it, in June 2026, so the syndrome is just now gaining recognition.
CKM syndrome affects 90 percent of Americans because it’s broadly defined to capture everyone on the continuum from those who might feel well but have early metabolic risk factors, to those with full-fledged heart disease. “It doesn’t mean that 90 percent of Americans require treatment,” Vaduganathan said. The goal isn’t to overmedicalize but to push prevention: “It’s more that 90 percent of Americans should be aware that they are at least at risk for progression of one or more of these conditions — metabolic, kidney or heart — and that early lifestyle management can help.”
Gilchrist pointed out that the guidelines even describe a “Stage 0,” which includes the other 10% of Americans. They may not technically have the syndrome but are still at risk for developing it if they don’t actively subscribe to a healthy lifestyle, she said.
So much of the American public falls between Stage 1 and Stage 4 CKM syndrome because of our typical lifestyle behaviors, said Joseph. “We live in a 24-hours-a-day society where we may struggle to eat healthy foods, be physically active and get enough sleep,” he said. Roughly 20 percent of U.S. adults also use tobacco products, he added, which ratchets up risk, too.
But our behaviors also occur in the context of our environments, Joseph pointed out. You might live in a rural area without easy access to a grocery store or in a city lacking green spaces or other safe areas to go out and be active. Or maybe your home is surrounded by factories that pump pollutants into the air. “Both the environmental foundation and the lifestyle behaviors are levers we’re trying to move,” Joseph said.
What are the treatments for CKM syndrome?
At early stages, treatment centers on lifestyle interventions. For instance, “we know that a Mediterranean-style diet can not only help mitigate blood pressure and blood sugar, but has also been shown to reduce long-term cardiovascular risk,” Joseph said. Beyond diet, the AHA guidelines for CKM syndrome also note being physically active, avoiding nicotine products and getting quality sleep plus, in people with extra weight, behavioral weight loss programs led by clinicians.
A handful of long-used medications are also still recommended to tackle specific risk factors and diseases in people at higher stages — for example, metformin to lower blood sugar, statins to combat high cholesterol and angiotensin-converting enzyme (ACE) inhibitors to control blood pressure.
But the biggest focus for people across the CKM spectrum is on new medications with broader effects across organs, the experts said. For instance, glucagon-like peptides (GLP-1s) can help with weight and lower blood sugar by slowing down digestion, which has been shown to benefit the heart and kidneys. Then there’s sodium-glucose cotransporter 2 (SGLT2) inhibitors, which help you urinate out sugar and are also proven to reduce heart failure admissions and stabilize kidney function, Joseph said. And nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) can limit fluid backup in the kidneys with upstream benefits for the heart.
We’re in such a “great era of medicine,” Gilchrist said, because we don’t just have drugs that lower one risk factor. With the CKM framework, we can find people at risk, she said, and “we can offer medicines that may actually help them stay out of the hospital and live longer.”