One in three U.S. adults has three or more risk factors for a condition that’s gaining recognition: cardiovascular-kidney-metabolic (CKM) syndrome. First defined in a 2023 American Heart Association (AHA) presidential advisory, CKM ties together heart, kidney, and metabolic health as interlinked drivers of cardiovascular disease (CVD). Yet, long before CKM had a name, millions were unknowingly progressing through its dangerous stages.
A first-of-its-kind study analysed the state-by-state prevalence of CKM syndrome using CDC Behavioral Risk Factor Surveillance System data from 2011 to 2023. The findings, published in JAAC: Advances, reveal that 80% of Americans have some form of CKM syndrome. Over 12 years, not a single state saw a decline.
West Virginia had the highest prevalence, with nearly 87% of residents affected by 2023, followed by Delaware, where rates rose from 76% to 83%. Colorado had the lowest, with nearly 72% impacted. Overall, CKM rates were highest in the Midwest and South.
CKM syndrome develops in stages. Stage 0 indicates no disease, while Stage 1 includes obesity or prediabetes. Stages 2 and 3 involve hypertension, high cholesterol, diabetes, or kidney disease, raising the risk for CVD. Stage 4 is the most severe. That’s where clinicians see a clinical diagnosis of heart failure, stroke, coronary heart disease, or kidney failure.
The analysis found nearly half of the states reported increases in CKM stages 1 through 3. Although Stage 4 rates declined nationally, Minnesota saw a significant rise in advanced-stage cases.
Routine health screenings are critical for slowing CKM progression and preventing CVD, but assessing these conditions together is still not common practice. It is important to educate the public that CKM syndrome isn’t just about managing obesity, diabetes, or heart disease separately. Without lifestyle and behavioural changes, one risk factor can snowball into several.
State-level variations in programmes also pose challenges. Many programmes only address diabetes self-management. There is a need to expand these to include other CVD risk factors to slow CKM progression.
Individuals, too, need to take an active role in monitoring their health. People should know their weight, blood pressure, and BMI. Routine testing during wellness visits is essential, and there is a need to stop ignoring borderline results.
To address rising CKM rates, the AHA has launched a pilot preventive health initiative in select cities and regions, including Atlanta, San Diego, Baton Rouge, Washington, D.C., Maryland, and Ohio (including Cincinnati and parts of Kentucky). The AHA plans to expand this CKM Health Initiative to 15 regions, reaching 250,000 Americans across 150 healthcare sites. The pilot brings together providers from primary care, cardiology, nephrology, and other specialties to take a more holistic approach.
Looking ahead, the research team plans to analyse clinical data from electronic health records to deepen understanding of CKM and develop a machine-learning model to predict and slow its progression.
Source: University of Delaware
Image Credit: Jeffrey C. Chase/ University of Delaware
References:
Chang R, Parekh T, Hagan KK et al. (2025) State-Level Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in the United States, 2011 to 2023. JACC: Advances. 4(6)_Part_1.
