This month's guest author, Dr. Chiadi Ndumele, is the chair of the American Heart Association’s Cardiovascular-Kidney-Metabolic Science Advisory Group, Director of Obesity and Cardiometabolic Research and Associate Professor of Medicine in the Division of Cardiology at Johns Hopkins University.
About 1 in 3 U.S. adults have at least three risk factors for cardiovascular-kidney-metabolic (CKM) syndrome, yet many have never heard of this condition and there is no single clinical practice guideline to treat people with CKM syndrome.
Last year, health experts began redefining cardiovascular disease (CVD) risk, prevention and management. For the first time, the American Heart Association defined the overlap in CVD, kidney disease, Type 2 diabetes and obesity as CKM syndrome. As the underlying conditions of CKM syndrome worsen, the risk of heart attack, stroke, heart failure and kidney and liver diseases increases.
The new approach, detailed in the 2023 presidential advisory published in the Association’s flagship peer-reviewed scientific journal Circulation, includes:
- CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage describes specific screenings and therapies.
- Screening for and addressing social factors that impact health.
- Collaborative care approaches among multiple specialties to treat the whole patient.
- Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The updated risk calculator adds a risk prediction for heart failure, thus estimating risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.
- Suggested updates to the risk algorithm to provide both 10- and 30-year cardiovascular disease risk estimates.
To address this complex health threat, the American Heart Association in July launched a four-year Cardiovascular-Kidney-Metabolic Health Initiative. The new initiative, supported by Novo Nordisk and Boehringer Ingelheim, will assess gaps in clinical care, identify areas for future research and implement guidelines and screening recommendations to provide clear and definitive advice for treatment.
The American Heart Association will collaborate on this initiative with the American College of Physicians, American Diabetes Association®, American Society of Nephrology, National Kidney Foundation and the STOP Obesity Alliance at the Milken Institute School of Public Health. The effort will engage 150 hospitals and sites across the nation, reaching more than 265,000 patients.
“Given the complexity and interconnectedness of CKM conditions, it is important to take a holistic approach, bringing best practices to life across the lived experiences of individuals and the health care professionals who treat them,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association. “By having a person-centered focus that harmonizes care, we will be able to drive earlier identification of cardiovascular- kidney-metabolic conditions, implement better treatment and care, and increase awareness, knowledge and skill-building.”
Informed by the new clinical compendium, the Association will expand CKMH measures within its Get With The Guidelines® and outpatient data registries, as well as develop a CKM recognition program for individual health care professionals and health systems dedicated to improving CKM care. In collaboration with the Cardiometabolic Center Alliance, the American Heart Association will develop a scalable patient-centered certification supported by a national health system implementation science framework to improve treatment for CKM syndrome.
The CKM Health Initiative is part of the Association’s strategic investment in improving care for CKM conditions. Four of the Association’s Life’s Essential 8 — weight, blood pressure, lipids and blood glucose — are elements of metabolic dysfunction. When controlled, they lead to improved cardiovascular health, lowering the risk for heart disease, stroke, metabolic disorders, kidney disease and other major health problems.
In January, the Association unveiled its PREVENTTM (Predicting Risk of cardiovascular disease EVENTs) risk calculator, which incorporates CKM syndrome when evaluating heart attack, stroke and heart failure risk. The new initiative aims to increase systematic screening for social drivers of health and incorporate more community health workers and social workers into interdisciplinary care teams, among other efforts to combat negative social risk factors.
Due to the connections identified among these conditions, and as part of its second century vision for accelerating scientific breakthroughs, the American Heart Association in a separate endeavor will draw on its decades of experience to launch a novel patient-centric longitudinal registry of individuals living with obesity, including those prescribed treatment for weight management.
Learn more at heart.org/CKMHealth.