Study Finds Cardiovascular Disease Risk Can Develop Decades Earlier in People with Diabetes and Kidney Disease

New research presented at the American Heart Association’s Scientific Sessions 2024 has revealed a troubling link between cardiovascular-kidney-metabolic (CKM) syndrome and early cardiovascular disease (CVD) risk. CKM syndrome—a condition characterized by the connections between cardiovascular disease, kidney disease, obesity, and diabetes—may accelerate cardiovascular risk by as much as 28 years, particularly in patients with both type 2 diabetes and chronic kidney disease (CKD).

Early Onset of Cardiovascular Risk

The study reported that individuals with both CKD and type 2 diabetes face elevated cardiovascular disease (CVD) risks much earlier than those without these conditions. Specifically, females with both conditions see an increased risk at age 42, while males face this risk as early as age 35. These findings reflect a startling acceleration—26 years earlier for females and 28 years earlier for males compared to individuals without these diseases.

Even for those with only one condition, the timeline remains significant. Researchers found that type 2 diabetes advances cardiovascular risk by nine years in females and 11 years in males, while CKD shifts the risk by eight years for both genders.

“Our findings help to interpret the combination of risk factors that will lead to a high predicted [cardiovascular disease] risk and at what age they have an impact on risk,” explained Vaishnavi Krishnan, lead study author and medical student at Boston University School of Medicine.

Gaps in Risk Recognition

CKM syndrome highlights the interconnected nature of CVD, kidney disease, and metabolic factors, as well as gaps in current screening methods. Subtle early warning signs, such as borderline-elevated blood pressure or glucose levels, may go unnoticed in patients who do not yet meet diagnostic thresholds for CKD or diabetes.

Experts stress the urgency of early intervention. “This is truly a call to action, to both identify those at such risk and to begin more aggressive treatment, earlier than we have traditionally felt necessary,” said Richard Wright, MD, a cardiologist at Providence Saint John’s Health Center.

Limitations and Next Steps

The study was a simulated analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2020 and predictive modeling tools, rather than clinical data from actual patients. While not as robust as a prospective clinical study, experts agree that even simulated findings provide critical insights into risk progression and the need for earlier intervention.

“This interesting and provocative analysis is only a simulation and is not based on actual clinical data, but nevertheless, dramatically points out the potential ‘more-than-additive’ risk these conditions possess in predicting future cardiovascular events,” Wright noted.

The findings underscore the need for healthcare professionals to consider CKM syndrome’s early warning signs and adopt proactive strategies to mitigate risk. With lifestyle interventions and advanced pharmacologic therapies, the "vicious CKM spiral" can be interrupted, ultimately improving both lifespan and quality of life.

A Path Forward: Improving Heart Health in CKM Syndrome

The American Heart Association has launched a four-year Cardiovascular-Kidney-Metabolic (CKM) Health Initiative to address gaps in clinical care, develop screening guidelines, and improve patient outcomes. Key recommendations for patients at risk include:

• Follow a heart-healthy diet low in sodium and saturated fats and rich in fruits and vegetables
• Exercise regularly and stay physically active
• Avoid smoking and exposure to second-hand smoke
• Manage stress levels through mindfulness and other techniques