This year’s Heart Week shines the spotlight on the newly coined ‘CKM syndrome’.
Cardiovascular-kidney-metabolic (CKM) syndrome describes the interplay between heart, kidney and metabolic diseases. It is exceptionally common with a profound burden on premature morbidity and mortality.
Cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetes are common vascular conditions that place a heavy burden on our health system and community. As well as sharing many risk factors, the three conditions often occur together with approximately 1 in 4 Australians living with one or more of these conditions.1
WHAT IS CKM SYNDROME?
In October 2023, the American Heart Association published a scientific statement defining the term cardiovascular-kidney-metabolic (CKM) syndrome: ‘a systemic disorder characterised by pathophysiological interactions among metabolic risk factors, chronic kidney disease and the cardiovascular system leading to multiorgan dysfunction and a high rate of cardiovascular outcomes.’2
CKM syndrome includes individuals at risk of and those living with CVD, which potentially relates to or complicates metabolic risk factors or CKD.
While the close links among the conditions that make up CKM syndrome are widely known, the new definition supports concerted efforts to diagnose and manage the syndrome to improve cardiovascular outcomes for affected patients. It’s a stern reminder that obesity and diabetes are strong predictors of heart and kidney diseases, emphasising the importance of multidisciplinary care, enhanced screening and risk-prediction efforts.2,3
CKM syndrome appears to accelerate atherosclerosis by driving known contributors: inflammation, dyslipidaemia, hypertension and insulin resistance.
STAGES OF CKM SYNDROME
With the new name comes a staging framework based on pathophysiology, risk and opportunities for prevention, management and treatment.2
Table 1. Stages of CKM syndrome2
| Stages | Definition |
| Stage 0 | No CKM risk factors: normal body mass index (BMI) and waist circumference, blood sugar, blood pressure, cholesterol levels; no evidence of CKD or subclinical or clinical CVD |
| Stage 1 | Excess dysfunctional adiposity |
| Stage 2 | Metabolic risk factors (elevated triglycerides and blood pressure levels, diabetes, metabolic syndrome) |
| Stage 3 | Early or subclinical CVD in CKM syndrome (high predicted CVD risk) or very high-risk CKD |
| Stage 4 | Clinical CVD in CKM syndrome |
The goal of the staging framework is to detect early, decrease risk factors and manage CKM syndrome proactively. It also promotes the concept of working towards ‘regression’ or moving to a lower stage, which can be achieved through lifestyle changes, weight loss, pharmacotherapy, patient education and support.2
Risk-based CVD prevention, which has been the mainstay of prevention, is emphasised in Stages 0–3.4 The new Aus CVD risk calculator considers several of these interconnected risk attributes and stages through the inclusion of measures of kidney function, metabolic health and social determinants.5
SCREENING FOR CKM SYNDROME
To detect CKM syndrome early, active screening for biological risk factors and social determinants of health is recommended. This includes assessing metabolic risk factors (e.g. BMI, blood sugar, haemoglobin A1c [HbA1c], cholesterol and triglyceride levels) and measures of kidney function (e.g. estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio [uACR]). Screening for social determinants of health assesses levels of disadvantage due to barriers to healthy lifestyle and health care access.3
The Aus CVD Risk calculator, based on the PREDICT-1° equation, allows for improved CVD risk estimation in people with type 2 diabetes, factoring in HbA1c, time since diagnosis of diabetes, uACR, BMI and use of insulin. Additionally, individuals living with moderate-to-severe CKD are automatically considered to be at high risk of CVD. The calculator uses a population-level summary measure of socioeconomic status (Socio-Economic Indexes for Areas [SEIFA] quintile) that reflects determinants such as education, housing, employment.5
Access the Australian CVD Risk Calculator HERE.
MANAGING CKM SYNDROME
Managing CKM syndrome involves a multidisciplinary approach targeting risk factors such as hypertension, dyslipidaemia, type 2 diabetes and obesity. Cardiovascular risk reduction should be achieved holistically with lifestyle modification, preventative pharmacotherapy and considerations for social context be prioritised.2,3,4
LEARN MORE ABOUT CKM SYNDROME THIS HEART WEEK
As part of Heart Week 2024 (6–12 May), the Heart Foundation is hosting the clinical webinar ‘Metabolic matrix’. The RACGP-accredited webinar, to be held on Thursday 9 May 7:00–8:30 pm AEST, will delve into the latest evidence and include case-based discussions for effectively managing CKM syndrome in primary care.
Facilitated by Professor Garry Jennings, Chief Medical Advisor, Heart Foundation, the expert panel includes:
- Dr Chiadi Ndumele, lead author of the AHA presidential advisory defining CKM syndrome; Robert E. Meyerhoff Assistant Professor, Department of Medicine, Johns Hopkins University, USA
- Professor Elif Ekinci, Director, Australian Centre for Accelerating Diabetes Innovations
- Professor Karen Dwyer, Director, Royal Melbourne Hospital and The University of Melbourne
- Associate Professor Gary Kilov, Director, Launceston Diabetes Clinic.
This webinar has been accredited by the RACGP for 1.5 Educational Activity CPD hours (activity no. 813797).
ABOUT HEART WEEK
Heart Week is Australia’s national heart health awareness week held every year in May. Heart Week provides an opportunity for health professionals and the Australian public to start a conversation about heart disease and take steps to improve their heart health.
This Heart Week everyday Australians are encouraged to understand their personal risk of developing heart disease and take action by booking in a Heart Health Check with their GPs.
Never miss a beat. Engage with your patients about heart health by downloading or ordering your free Heart Week resource pack here.
References:
- White SL. Chronic Kidney Disease, Diabetes & Cardiovascular Disease: Evidence Report 2021. Kidney Health Australia, Melbourne, Australia, August 2020.
- Ndumele CE, Rangaswami J, Chow SL, et al.; American Heart Association. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory from the American Heart Association. Circulation. 2023 Nov 14;148(20):1606-1635. doi: 10.1161/CIR.0000000000001184. Epub 2023 Oct 9. PMID: 37807924.
- Sebastian SA, Padda I, Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review. Curr Probl Cardiol. 2024 Feb;49(2):102344. doi: 10.1016/j.cpcardiol.2023.102344. Epub 2023 Dec 14.
- Khan SS, Coresh J, Pencina MJ, et al.; American Heart Association. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023 Dec 12;148(24):1982-2004. doi: 10.1161/CIR.0000000000001191.
- Commonwealth of Australia as represented by the Department of Health and Aged Care. Australian Guideline for assessing and managing cardiovascular disease risk. 2023.
