- A new report suggests that millions of U.S. adults are unaware they may have undiagnosed cardiovascular risk factors that begin outside the heart.
- An estimated 90% of Americans may have a cluster of chronic health conditions known as cardiovascular-kidney-metabolic (CKM) syndrome, which can lead to cardiovascular disease.
- A cardiologist explains the comorbidities of heart disease, diabetes, and kidney disease, and what you can do to protect your heart health.
When most people think of risk factors for cardiovascular disease, they likely consider their heart health.
Yet cardiovascular risks are also driven by other physiological processes that begin outside of the heart.
Metabolic health and cardiovascular health are intrinsically linked, with diabetes and kidney disease as significant risk factors for heart disease. Be that as it may, a 2025 survey shows that most people are unaware of this connection.
What’s more, a recent statistics report by the American Heart Association (AHA) notes that as many as 1 in 4 adults with diabetes are undiagnosed in the United States. Additionally, 9 in 10 U.S. adults with chronic kidney disease are undiagnosed in the United States due to factors such as a lack of screening.
The comorbidity of diabetes, kidney disease, and heart disease means that having one of these conditions raises the risk of developing another due to shared risk factors, including:
- high blood pressure
- high cholesterol
- high blood sugar
- excess weight
- reduced kidney function
The medical term describing the link between heart disease, diabetes, and kidney disease is cardiovascular-kidney-metabolic syndrome, or CKM syndrome, with upward of 90% of Americans unaware that they may have the disease.
If left untreated, complications from CKM syndrome can lead to disability and death from cardiovascular disease.
“We are encouraging people to become aware of the connection between conditions so they and their health care team can think about their overall health beyond individual conditions,” Stacey E. Rosen, MD, volunteer president of the AHA, said in a statement.
“Understanding the connection helps you better prevent complications through lifestyle changes and appropriate treatment.”
Other findings from the AHA statistics report highlight the prevalence of overlapping risk factors driving the prevalence of CKM syndrome in the United States:
- around half of adults have high blood pressure
- 1 in 3 adults has high cholesterol
- around 1 in 7 adults has kidney disease
- more than half of adults have prediabetes or diabetes
- over half of adults have a high waist circumference
“Each of these factors independently stresses the cardiovascular system,” said Jack Wolfson, MD, a board certified cardiologist. “Together, they create a perfect storm.”
Healthline spoke with Wolfson to learn more about how heart, metabolic, and kidney health are connected, and what people at risk for, or living with, CKM syndrome can do to minimize their cardiovascular risk.
This interview has been lightly edited and condensed.
Wolfson: Metabolic syndrome is not a single disease. It’s a cluster of metabolic dysfunction that includes abdominal obesity, insulin resistance, elevated triglycerides, low HDL, and high blood pressure.
Insulin resistance drives chronically elevated insulin levels, which promote inflammation, endothelial dysfunction, and vascular stiffness.
High triglycerides and small LDL particles increase atherogenic burden. Elevated blood pressure damages the inner lining of arteries.
Visceral fat releases inflammatory cytokines that further impair vascular health.
Over time, this metabolic environment leads to accelerated plaque formation, impaired nitric oxide production, arterial stiffening, and left ventricular hypertrophy.
The heart is forced to pump against higher resistance while being supplied by progressively diseased vessels, whereas Metabolic syndrome is essentially early cardiovascular disease in motion.
Wolfson: Diabetes, particularly type 2 diabetes, is fundamentally a disease of chronic hyperglycemia and insulin resistance.
Excess glucose in the bloodstream causes glycation of proteins and lipids, forming advanced glycation end products. These compounds stiffen blood vessels, damage the endothelium, and promote inflammation. High glucose levels also increase oxidative stress and impair nitric oxide production.
The result is reduced vascular flexibility and increased blood pressure. In addition, diabetes shifts lipid metabolism toward higher triglycerides and small, dense LDL particles, which are more likely to penetrate arterial walls.
At the cardiac level, diabetes contributes to diabetic cardiomyopathy, characterized by myocardial fibrosis, impaired relaxation, and eventually reduced contractility. Diabetes does not just increase plaque risk; it directly injures blood vessels and heart muscle.
Wolfson: The heart and kidneys function as a tightly integrated system. When kidney function declines, the body retains sodium and fluid. This increases blood volume and places additional workload on the heart.
Chronic fluid overload contributes to hypertension and ventricular remodeling. Kidney disease also activates the renin-angiotensin-aldosterone system, increasing vasoconstriction and promoting fibrosis in both the kidneys and the heart.
Elevated phosphorus, uremic toxins, and chronic inflammation further damage vascular tissue.
Conversely, when the heart weakens and cardiac output declines, the kidneys receive less perfusion. Reduced blood flow worsens kidney function, creating a vicious cycle known as cardiorenal syndrome.
Kidney dysfunction is both a cause and consequence of heart failure.
Wolfson: CKM syndrome refers to cardiovascular, kidney, and metabolic dysfunction occurring together.
Warning signs include elevated fasting glucose or insulin, abdominal weight gain, high triglycerides, high blood pressure, declining estimated GFR, elevated urine albumin, chronic fatigue, shortness of breath with exertion, lower extremity swelling, sleep disturbances, and brain fog.
Often, early CKM syndrome is silent. Laboratory testing may reveal abnormalities long before symptoms appear.
This is why testing for insulin resistance, kidney markers, lipid particle number, and inflammation is critical.
Wolfson: Protection begins with correcting the underlying metabolic terrain.
Focus on real, nutrient-dense food that stabilizes blood sugar and reduces inflammation. Prioritize high-quality protein, healthy fats, wild seafood, pastured meats, and organ foods rich in micronutrients that support mitochondrial function.
Restore insulin sensitivity through strength training, daily movement, adequate sleep, and sunlight exposure to support circadian biology.
Reduce toxic burden, including ultra-processed foods, environmental chemicals, plastics, and chronic psychological stress.
Support vascular health through nutrients that enhance nitric oxide production and mitochondrial efficiency. Magnesium, omega-3 fatty acids, CoQ10, and targeted amino acids such as arginine and citrulline can be helpful when clinically appropriate.
Measure fasting insulin, advanced lipid markers, kidney function, inflammatory markers, oxidative stress, and albuminuria.
CKM syndrome develops gradually, but it can also be reversed gradually. When we correct metabolic dysfunction at its root, the heart, kidneys, and vascular system regain resilience.
Source link : https://www.healthline.com/health-news/cardiovascular-risk-factors-metabolic-health
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Publish date : 2026-02-28 07:00:00
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