90 percent of U.S. adults have this syndrome — but most have never heard of it
At the University of North Carolina Cardiovascular-Kidney-Metabolic (CKM) Syndrome Clinic, Susan Gilchrist, a preventive cardiologist and epidemiologist, sees patients all the time who don’t know what CKM is and aren’t sure why they’re in her clinic.
This is not surprising; CKM syndrome was just coined by the American Heart Association (AHA) in 2023. And roughly 9 in 10 U.S. adults (the same number of people estimated to have the disease) have never heard of it.
Muthiah Vaduganathan, a cardiologist at Brigham and Women’s Hospital who has conducted groundbreaking studies on CKM syndrome, said CKM syndrome is not a single disease but “a broad disease that recognizes the overlap between cardiovascular, renal, and metabolic conditions such as diabetes and obesity.” Doctors have long known that people often have more than one of these conditions at the same time. Vaduganathan said CKM syndrome reflects a newer understanding that the same factors — particularly extra weight, high blood pressure, high blood sugar, abnormal cholesterol and decreased kidney function — can contribute to the onset and progression of all three diseases.
The good news is that similar therapies can be used to manage conditions in the CKM triangle, Vaduganathan said.
How does CKM syndrome begin and progress?
Researchers have described CKM syndrome as a four-stage process; They reflect how symptoms and risk factors gradually accumulate, increasing the likelihood of a heart attack or kidney failure.
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Stage 1: They include people with extra fat tissue, defined as a body mass index (BMI) of 25 or higher or a waist circumference of 88 centimeters or more in women and 102 centimeters or more in men, and people with “dysfunctional” fat tissue, who do not have a larger body but show signs of poor glucose tolerance, such as prediabetes. Because BMI cannot distinguish lean body mass from fat, it can misclassify short or muscular people as overweight; so experts often use it in conjunction with other metrics here to identify those who fall into this at-risk group, Gilchrist said.
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Stage 2: They include people with metabolic risk factors that often result from extra fatty tissue, such as high levels of a type of fat in the blood called triglycerides, high blood pressure, metabolic syndrome (a set 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. Being categorized requires blood testing, usually done during a routine physical exam.
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Stage 3: They include those in earlier stages who have developed presymptomatic heart disease, such as atherosclerosis or heart failure, and those with very high-risk CKD or a greater than 20 percent risk of heart attack within the next 10 years, according to the AHA’s PREVENT calculator. Because the disease may still be silent at this point, a person is classified when their doctor orders screening based on the above risk factors.
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Stage 4: It includes people who have been diagnosed with stroke, heart failure, coronary heart disease, peripheral artery disease or atrial fibrillation from the above stages. This stage, which can occur with or without kidney disease (stage 4a), covers the most severe consequences of CKM syndrome and brings with it a high risk of heart attack in the future.
This framework helped Gilchrist explain to patients why weight matters to health: Carrying excess weight alone does not mean disease; but it can put you on a path towards disease. Large waist circumference and high blood sugar, in particular, are signs of what Gilchrist calls “metabolically dangerous” fat. He said it releases inflammatory proteins into the blood and can improve your body’s “fight or flight” stress state.
This combination can raise blood pressure and the level of some fats in the blood and make cells resistant to insulin (which helps with sugar uptake), releasing more sugar into the blood. Both high blood sugar and high blood pressure can damage the small blood vessels that feed the kidneys, damaging their ability to filter waste and extra fluid, said endocrinologist Joshua Joseph of Ohio State University Wexner Medical Center. Fluid supplementation increases blood volume, strains the heart and further elevates blood pressure, which begins a downward spiral toward cardiac events and kidney failure, Joseph said.
Why is CKM syndrome becoming a more common diagnosis?
The CKM framework was only formalized in 2023, and physician guidelines for identifying and managing it were formalized in June 2026, so the syndrome is only now beginning to be recognised.
CKM syndrome affects 90 percent of Americans because it is defined broadly to include everyone in the process, from those who feel well but have early metabolic risk factors to those with full-fledged heart disease. “This doesn’t mean that 90 percent of Americans need treatment,” Vaduganathan said. The goal is to promote prevention, not excessive medical intervention: “90 percent of Americans should be aware that they are at least at risk of developing one or more of these conditions (metabolic, renal, or cardiac) and that early lifestyle management can help.”
Gilchrist noted that the guidelines even define a “Phase 0” that covers another 10 percent of Americans. They may not technically have the syndrome, but they’re still at risk of developing it if they don’t actively adopt a healthy lifestyle, he said.
The majority of Americans fall between Stage 1 and Stage 4 CKM syndrome because of our typical lifestyle behaviors, Joseph said. “We live in a 24-hour-a-day society where we can struggle to eat healthy foods, be physically active and get enough sleep,” he said. He added that about 20 percent of U.S. adults also use tobacco products, increasing the risk.
But Joseph noted that our behavior also occurs in the context of our environment. You may live in a rural area without easy access to a grocery store, or in a city without green spaces or other safe spaces to get outside and be active. Or maybe your home is surrounded by factories that pump pollutants into the air. “Both the environmental baseline and lifestyle behaviors are levers we are trying to move,” Joseph said.
What are the treatments for CKM syndrome?
In the early stages, treatment focuses on lifestyle interventions. For example, “We know that a Mediterranean-style diet not only helps reduce blood pressure and blood sugar, but also reduces long-term cardiovascular risk,” Joseph said. Beyond diet, the AHA guidelines for CKM syndrome also specify being physically active, avoiding nicotine products, and getting quality sleep, as well as behavioral weight loss programs conducted by clinicians in overweight people.
A handful of drugs long used to combat certain risk factors and diseases in people at higher stages are also still recommended — 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 on the CKM spectrum is new drugs that have broader effects on organs, experts said. For example, glucagon-like peptides (GLP-1s) may help with weight loss and lower blood sugar by slowing digestion, which has been shown to benefit the heart and kidneys. There are also sodium-glucose cotransporter 2 (SGLT2) inhibitors, which help excrete sugar through the urine and have also been proven to reduce heart failure admissions and stabilize kidney function, Joseph said. Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) may limit fluid supply to the kidneys with positive benefits for the heart.
“We’re in a great age in medicine,” Gilchrist said, because we don’t have drugs that just reduce one risk factor. With the CKM framework, he said, we can find people at risk and “deliver medications that can help them stay out of hospital and live longer.”
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