A new scientific study published today in Circulation: Population Health and Outcomes, a peer-reviewed journal of the American Heart Association, reveals that nearly 8 out of 10 young adults, average age 23, already show signs of cardiovascular-kidney-metabolic (CKM) syndrome, a condition that significantly increases the risk of future heart disease, kidney disease, and diabetes. The research, which analyzed data from 1,283 participants in the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, found that those with more advanced CKM syndrome stages had early indicators of arterial injury, underscoring the need for cardiovascular risk assessment and prevention efforts to start much earlier in life.
CKM syndrome is a newly defined condition that describes the interconnected relationship between obesity, diabetes, chronic kidney disease, and cardiovascular disease. It is categorized into stages from 0 (no risk factors) to 4 (existing cardiovascular conditions). The study participants were primarily in CKM syndrome stages 1-3, meaning they had excess adiposity, metabolic risk factors, or subclinical cardiovascular disease. Notably, none were in stage 4, which includes overt cardiovascular disease.
Researchers assessed cardiovascular health using two complementary tools: CKM syndrome staging and the American Heart Association's Life's Essential 8™ metrics, which evaluate key health behaviors and factors such as diet, physical activity, tobacco use, sleep, weight, cholesterol, blood sugar, and blood pressure. They also used ultrasound imaging to measure the thickness of the carotid artery walls, an early marker of atherosclerosis.
The findings showed a clear association: participants with higher CKM syndrome stages had poorer Life's Essential 8 scores and exhibited early arterial injury, including thicker carotid artery walls. This suggests that the pathological processes leading to cardiovascular disease begin in young adulthood, well before clinical symptoms appear.
“The study shows that CKM syndrome staging and Life’s Essential 8 are complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury, plaque build-up and, ultimately, at higher risk for future cardiovascular events,” said study author Donald Lloyd-Jones, M.D., M.S., a cardiologist at Boston Medical Center and professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine. Lloyd-Jones is also a former volunteer president of the American Heart Association.
Given the young age of the participants, the standard risk prediction equations (PREVENT™) are not applicable, as they were designed for adults aged 30-79. Instead, Lloyd-Jones recommends that clinicians focus on optimizing Life's Essential 8 metrics with young patients. “For people in their 20s, we want to focus on improving cardiovascular health,” he said. The Life's Essential 8 framework is designed for measuring, monitoring, and improving cardiovascular health at any age, but especially in adolescents and young adults.
The study's findings carry significant public health implications. With obesity rates in the U.S. at about 40% of adults and 20% of youth, the prevalence of CKM syndrome among young adults is a growing concern. The researchers conclude that there are opportunities to improve cardiovascular health and prevent disease progression long before cardiovascular disease becomes clinically apparent. They call for prevention efforts to begin earlier in life, potentially during childhood or adolescence.
However, the study has limitations, including its cross-sectional design, which cannot establish cause and effect, and the use of self-reported health behavior data. Additionally, the study population included many individuals from disadvantaged backgrounds, so the findings may not be generalizable to all young adults. Long-term studies are needed to determine how CKM syndrome stage in young adulthood relates to future cardiovascular risk.
The American Heart Association has issued a first-ever guideline on cardiovascular-kidney-metabolic syndrome, and this study underscores the urgency of implementing its recommendations. For more information on CKM syndrome and Life's Essential 8, visit the American Heart Association's website at heart.org.
