A national study based on self-reported data from the U.S. Centers for Disease Control has revealed that more than 80 percent of adults in the United States now exhibit some stage of cardiovascular–kidney–metabolic or CKM syndrome. This condition, which includes obesity, diabetes, kidney dysfunction, hypertension, and high cholesterol, has increased significantly across all states. This raises serious public health concerns about long-term disease burden.
CKM Syndrome: Widespread Rise in Cardiovascular–Kidney–Metabolic Syndrome in the United States
Background
The American Heart Association first recognized CKM syndrome in a 2023 presidential advisory in which it reflects on the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system, and the profound impact of these on morbidity and mortality. It further provided guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome.
Nevertheless, even before this syndrome was defined, millions of Americans were unknowingly progressing through the dangerous stages of this condition. Tarang Parekh, assistant professor of epidemiology at the University of Delaware, and colleagues at Houston Methodist Hospital and Harvard Medical School, examined its state-level prevalence using self-reported 2011-2023 data from the Behavioral Risk Factors Surveillance System of the CDC.
Findings
• Widespread Prevalence: More than 80 percent of adults in the United States showed signs of cardiovascular–kidney–metabolic or CKM syndrome. These include conditions such as overweightness and obesity, prediabetic state, diabetes, kidney dysfunction and related issues, hypertension, and high cholesterol levels.
• National Increase in Early Stages: Stages 1 to Stage 3, or the so-called early to moderate stages of CKM syndrome, have risen in every U.S. state. Note that these stages represent accumulating risk factors before full cardiovascular or kidney disease develops.
• No State Improvement: No state reported a decline in cardiovascular–kidney–metabolic syndrome rates over the 12-year period studied or based on the 2011-2023 data from the CDC. This is indicative of the fact that there is a nationwide trend in which there are no localized success stories in reversing or slowing the condition.
• Mixed Trends in Advanced Stages: Stage 4 of CKM or full cardiovascular disease or kidney failure declined slightly overall, but some states, including Minnesota, actually experienced an increase in advanced-stage CKM cases.
• Healthcare Fragmentation: The fragmented U.S. healthcare system was identified as a critical problem. The system considers and attends to different but related risk factors in separate silos. This particular fragmentation delays diagnosis, prevents early intervention, and further allows conditions to worsen undetected.
Implications
The study underscores the fact that CKM syndrome reflects a failure of the current fragmented healthcare system in the U.S. Risk factors such as weight, kidney function, blood pressure, and blood sugar are often treated separately. Remember that this delays detection and coordinated care. Researchers argue for a more integrated approach that addresses all risk factors simultaneously through early screening and multi-specialty collaboration.
Nevertheless, as a response, the American Heart Association launched a CKM Health Initiative in selected regions in the United States. This is a pilot program seeking to align and unite cardiology, nephrology, and primary care under one system. Researchers also plan to develop machine-learning models using health records to predict CKM progression and guide earlier interventions that can prevent worsening outcomes for millions of patients.
FURTHER READINGS AND REFERENCES
- Chang, R., Parekh, T., Hagan, K. K., Javed, Z., and Ostrominski, J. W. 2025. “State-Level Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in the United States, 2011 to 2023.” JACC: Advances. 4(6): 101754. DOI: 1016/j.jacadv.2025.101754
- Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., Coresh, J., Mathew, R. O., Baker-Smith, C. M., Carnethon, M. R., Despres, J.-P., Ho, J. E., Joseph, J. J., Kernan, W. N., Khera, A., Kosiborod, M. N., Lekavich, C. L., Lewis, E. F., … Lo, K. B. 2023. “Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association.” Circulation. 148(20): 1606-1635. DOI: 1161/cir.0000000000001184