New research published online today in JAMA highlights the widespread prevalence of cardiovascular-kidney-metabolic (CKM) syndrome among US adults. Findings also show that adults aged 65 years and older, men, and Black adults face an increased risk of advanced stages.

Between 2011 and 2020, almost 90% of US adults met the criteria for stage 1 or higher of CKM syndrome and 15% met the criteria for advanced stages (stages 3 or 4), however, there was no improvement in these prevalence rates over the study period.

“The lack of progress, in part, may reflect concomitant improvement and worsening of different risk factors over time,” researchers from Brigham and Women’s Hospital and Harvard Medical School wrote.

In recent years, there has been a shift in the medical and scientific communities’ appreciation for the connections among CKM diseases and for their combined impact on cardiovascular mortality. In 2023, the American Heart Association introduced the framework for CKM syndrome which included staging and corresponding screening approaches. The stages are based on risk factors and established disease and range from 0 (no risk factors) to 4 (established cardiovascular disease [CVD]), according to the study.

Citing a lack of studies on the stages of CKM syndrome in the US population, investigators conducted a nationally representative study to examine “the prevalence and temporal evolution of CKM syndrome stages,” they wrote.

Investigators used the National Health and Nutrition Examination Survey (NHANES; 2011 to March 2020) to identify adults aged 20 years and older who underwent physical examination and fasting laboratory measurements.

A total of 10 762 adults (mean age, 47.3 years; 51.8% women) were categorized into the following CKM syndrome stages:

• Stage 0: No CKM risk factors (eg, hypertension)
• Stage 1: Excess or dysfunctional adiposity
• Stage 2: Additional metabolic risk factors or moderate- or high-risk chronic kidney disease (CKD)
• Stage 3: Very high-risk CKD or high-predicted 10-year CVD risk
• Stage 4: Established CVD (eg, coronary artery disease)

“Advanced CKM syndrome stages were defined as stages 3 or 4 because these identify individuals with or at high risk of CVD,” first author Rahul Aggarwal, MD, clinical fellow in medicine, Brigham and Women’s Hospital, and colleagues noted.

Temporal trends between 2011-2012 and 2017-March 2020 were assessed by CKM stage and for advanced stages using linear regression. Prevalence of advanced stages was compared among subgroups (age, sex, race, and ethnicity) using log-binomial regression.

FINDINGS

Among the cohort, 64.4% were White, 15.3% were Hispanic, 11.5% were Black, 5.6% were Asian American, and 3.3% were other races and ethnicities.

Between 2011 and 2020, 10.6% of US adults met criteria for stage 0, 25.9% for stage 1, 49.0% for stage 2, 5.4% for stage 3, and 9.2% for stage 4. Aggarwal and colleagues added that the prevalence of each stage did not significantly change during the study period (P for trend >.05 for each stage).

Advanced stages of CKM syndrome occurred in 14.6% of participants and did not significantly change over the study period, according to the study.

Prevalence varied by race, sex, age. When investigators analyzed the prevalence of CKM syndrome among the subgroups, they observed that adults aged 65 years and older were more likely to have advanced stages than were those aged 45 to 64 years (55.3% vs 10.7%; P < .001) and those aged 20 to 44 years (55.3% vs 2.1%; P < .001). Also, 18.2% of adults aged 20 to 44 years had stage 0.

In addition, men were more likely than women to have advanced stages of CKM syndrome (16.9% vs 12.4%; adjusted prevalence ratio [PR] 1.36, 95% CI 1.24-1.49; P < .001). Black adults were significantly more likely to have advanced stages compared to White adults (18.9% vs 13.8%; adjusted PR 1.38, 95% CI 1.24-1.55; P < .001).

“Poor CKM health is widespread in the US population, especially among Black adults. Equitable health care approaches prioritizing CKM health are urgently needed,” Aggarwal et al.

For interviews with Chiadi Ndumele, MD, PhD, MHS, chair of the writing committee for the AHA’s scientific statement on prevention and management of CKM syndrome and associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University, please see:

• "CKM Syndrome" Defines a Very Wide Target and Medicine is Ready, Says Chiadi Ndumele, MD, PhD, MHS
• The 4 Stages of CKM Syndrome Offer Opportunities to Stop Progression, Promote Regression
• Primary Care is the Quarterback in Effective Care for Cardiovascular-Kidney-Metabolic Syndrome
• How to Build Assessment for Cardiovascular-Kidney-Metabolic Syndrome into Primary CVD Prevention

Reference: Aggarwal R, Ostrominski JW, Vaduganathan M. Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011-2020. JAMA. Published online May 8, 2024. doi:10.1001/jama.2024.6892