The American Heart Association (AHA) has called for significant change to health delivery and to research in order to optimise cardiovascular-kidney-metabolic (CKM) health.
In an AHA presidential advisory, published in Circulation late last year [link here], the AHA described poor CKM health as “a public health emergency” which disproportionately impacts disenfranchised populations with adverse social determinants of health (SDOH).
It defined CKM syndrome as “a systemic disorder characterised by pathophysiological interactions among metabolic risk factors, CKD, and the cardiovascular system leading to multiorgan dysfunction and a high rate of adverse cardiovascular outcomes.”
The advisory said a definition was needed to facilitate communication between the scientific community and community stakeholders and to underscore the importance of considering CKM syndrome when determining health policy and investment in research or public health initiatives.
Recognising the progressive nature of CKM syndrome, it proposed a staging rationale comprising:
- Stage 0: No CKM risk
- Stage 1: Excess or dysfunctional adiposity
- Stage 2: Metabolic risk factors and CKD
- Stage 3: Subclinical CVD in CKM, and
- Stage 4: Clinical CVD in CKM.
Stage 4 was further divided into stages 4a (without kidney failure) and 4b (with kidney failure).
The advisory also noted the opportunities to promote CKM stage regression which should be emphasised in clinical encounters and educational campaigns.
“This is achieved most reliably through marked intentional weight loss and significant lifestyle changes, which have been associated with reductions in adipose tissue and improvements in glucose tolerance (stage 1); remission of diabetes, hypertension, hyperlipidemia, and MetS, as well as improvements in kidney function (stage 2); and reversals of adverse cardiac remodeling (stage 3),” it said.
The advisory noted risk-enhancing factors included South Asian ancestry, low socioeconomic status, a family history of diabetes or kidney failure, sleep disorders, mental health disorders, chronic inflammatory conditions, and higher adverse SDOH burden.
Sex-specific risk enhancers included premature menopausal transition, adverse pregnancy outcomes and polycystic ovarian disease.
It also outlined screening approaches in both early life and adulthood in order to identify opportunities for preventive action to halt or reverse disease progression.
The AHA emphasised the importance of interdisciplinary care across all stages of CKM syndrome as well as incorporation of SDOH into the care model for CKM prevention and management,
It proposed the interdisciplinary care team includes primary care, nephrology, endocrinology and cardiology, as well as pharmacy, nursing, social workers and community health.
“Optimising CKM health in the population will require a multifaceted, concerted and patient-centred effort involving multilevel partnerships among clinical entities, policymakers, payers, and numerous stakeholders, as well as the enhancement of education and research related to CKM syndrome,” it said.
“It will also necessitate changes to clinical workflows, care team composition, insurance coverage and reimbursement strategies to support interdisciplinary care, integrated obesity management, consideration of SDOH and equitable access to pharmacotherapies, and application of proven strategies to support implementation of CKM guidance within and across health centres.”
⚠️Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the @AHAScience
📌review of the scientific literature
📌 summarize the evidence
📌 gaps related to the science,… pic.twitter.com/EbOwEbbIga
— Alfonso Valle (@ValleAlfonso) October 9, 2023