Highlights
Higher Cardiovascular-Kidney-Metabolic (CKM) syndrome stages are linked to worse cardiac function and increased heart failure risk in older adults.
The ARIC Study reveals that over 90% of participants had suboptimal CKM health, with significant implications for clinical practice.
CKM staging provides a structured framework to predict heart failure and guide preventive interventions.
Background
Cardiovascular-Kidney-Metabolic (CKM) syndrome represents a complex interplay of metabolic risk factors, kidney disease, and cardiovascular dysfunction. Its prevalence is alarmingly high among older adults in the United States, but the association between CKM stages and heart failure (HF) risk remains uncertain. This study aimed to clarify this relationship using data from the Atherosclerosis Risk in Communities (ARIC) Study.
Study Design
The study included 5,646 participants from the ARIC Study (Visit 5, 2011-2013) who underwent echocardiography. Participants were categorized into CKM stages (0-4b) based on the American Heart Association framework, which considers adiposity, metabolic risks, kidney disease, and cardiovascular disease. The study evaluated cardiac remodeling, function, and incident HF risk over a median follow-up of 9 years.
Key Findings
Only 24 participants (0.4%) had optimal CKM health (Stage 0), while the majority were in Stage 3 (56%) or Stage 4 (32.6%). Higher CKM stages were associated with adverse left ventricular remodeling, worse systolic and diastolic function, and greater progression of cardiac dysfunction. Incident HF risk escalated with CKM stage: Stage 3 had 15.1 events/1000 person-years (adjusted HR 3.6), and Stage 4 had 37.4 events/1000 person-years (adjusted HR 8.3). The trend was statistically significant (P<0.001).
Expert Commentary
This study underscores the clinical utility of CKM staging in identifying high-risk individuals for HF. The findings align with current guidelines emphasizing early intervention in metabolic and kidney diseases to mitigate cardiovascular risk. Limitations include the observational design and potential unmeasured confounders, but the large, community-based cohort enhances generalizability.
Conclusion
CKM syndrome staging effectively stratifies HF risk and highlights the pervasive burden of suboptimal CKM health in older adults. These insights advocate for integrated care models addressing metabolic, kidney, and cardiovascular health to prevent HF in aging populations.
Funding
The ARIC Study is supported by the National Heart, Lung, and Blood Institute. ClinicalTrials.gov Identifier: Not applicable (observational study).
References
1. Lassen MCH, et al. Circulation. 2026;153(17):1268-1280. PMID: 41919388.