Nearly 9 in 10 U.S. adults have at least one risk factor for a group of health problems that are more connected than they may realize.

Heart health, kidney health, blood pressure, blood sugar and weight can influence one another. This connection is known as cardiovascular-kidney-metabolic syndrome, or CKM — and new guidelines are encouraging health care professionals to identify and address these risks earlier.

The goal isn't to predict who will develop heart disease, kidney disease or diabetes. It's to recognize risk sooner, when there may be more opportunities to proactively lower it.

“We used to think that these conditions were independent,” said Dr. Kobina Wilmot, a preventive cardiologist at Novant Heart Health & Vascular Institute - Mooresville. “What we’ve realized is that these conditions affect one another.”

Here Wilmot shares more about what everyone should know about CKM syndrome.

Does having one CKM risk factor mean I will develop heart disease?

No. A risk factor is not a guarantee. But it is a reason to pay attention and work with your care team on prevention.

The guidelines describe CKM health along a spectrum. People can move toward greater risk over time, but early stages can often improve with lifestyle changes and, when appropriate, treatment.

What are the CKM stages?

1. Stage 0: No known CKM risk factors
2. Stage 1: Excess weight, obesity, increased waist circumference and/or prediabetes
3. Stage 2: Risk factors such as high blood pressure, unhealthy cholesterol or triglyceride levels, Type 2 diabetes, metabolic syndrome or chronic kidney disease — but no diagnosed cardiovascular disease
4. Stage 3: Early or “silent” cardiovascular disease, such as plaque buildup in the arteries or early changes in heart function, even if it has not caused symptoms or blood test results that signal risk to the heart
5. Stage 4: Established cardiovascular disease, such as coronary heart disease, heart failure, stroke, peripheral artery disease or atrial fibrillation
   

What lifestyle changes make the biggest difference?

Focus on sustainable basics rather than a “perfect” plan.

Regular activity can lower blood pressure and support weight management, healthy blood sugar and overall cardiovascular health. The American Heart Association recommends 150 to 300 minutes of moderate-intensity activity a week, or 75 to 150 minutes of vigorous activity. That activity can be spread out among easy-to-access activities like a brisk walk for the whole family.

For eating habits, do your best to:

• Choose mostly whole, minimally processed foods.
• Build meals around plants, including fruits, vegetables, beans and whole grains.
• Limit highly processed foods and sugar-sweetened drinks.
• Choose fish, poultry or plant proteins more often than red and processed meats.
• Reduce sodium if high blood pressure is a concern.

Sleep matters, too. Poor sleep can make it harder to manage appetite, blood pressure and overall cardiovascular risk.

These recommendations align with the American Heart Association’s Life’s Essential 8: eat better, be more active, avoid tobacco, get healthy sleep, manage weight, and know and manage your blood pressure, cholesterol and blood sugar.

Think of these guidelines as goals: it’s great if you can meet them, but a little bit of effort toward eating healthier or being more active is progress. That’s what we’re after when it comes to prevention: progress, not perfection.

How are kidney disease and heart disease connected?

Kidney disease can be easy to miss because it often does not cause obvious symptoms early on. But abnormal kidney test results can be an early warning sign of cardiovascular risk.

Kidney health involves both how well the kidneys filter blood and whether they are leaking protein into the urine. A urine albumin-creatinine ratio, or UACR, can identify excess protein in the urine — sometimes before a person’s kidney filtration rate declines.

People can ask their health care team:

• What is my kidney filtration rate, or eGFR?
• Have I had a urine albumin-creatinine ratio (UACR) test?
• Do my results suggest a need for more frequent monitoring or treatment?

These tests are not right for every person in every situation, but they can help a clinician understand risk — particularly for people with diabetes, high blood pressure or a family history of kidney or heart disease.

How do the new CKM guidelines change how health care teams approach CKM prevention and treatment?

Ideally, patients will see more coordination among primary care clinicians, cardiologists, kidney specialists, endocrinologists and other members of their care team.

In practice, that may mean the first clinician to identify a risk factor starts the conversation rather than waiting for another specialty to become involved.

It may also mean considering treatments that can support several parts of a patient’s health.

For example, some GLP-1–based medicines used for Type 2 diabetes or obesity may help with weight management and lower cardiovascular risk for selected patients. These medicines are not appropriate for everyone, so treatment decisions should be individualized.

Medications that support heart and kidney health such as ACE inhibitors that lower blood pressure and non-steroidal MRAs that protect the kidneys could also benefit some patients.

What questions can I ask my health care team about my risk for CKM?

You do not need to arrive at an appointment having done hours of medical research. But it can help to ask direct questions, especially if you have concerns about diabetes, high blood pressure, kidney health or family history.

Two simple questions you can bring to your next appointment include:

• What are my biggest CKM risk factors right now?
• What is one realistic change that would make the biggest difference for me?