Nearly 90% of US Adults Meet Cardiovascular-Kidney-Metabolic Syndrome Criteria


The analysis of NHANES data revealed almost 90% of adults meet the criteria for stage 1 or greater CKM syndrome, consistent from 2011-2020.

Rahul Aggarwal, MD | Credit: LinkedIn

Rahul Aggarwal, MD

Credit: LinkedIn

Nearly 90% of US adults meet the criteria for ≥ stage 1 cardiovascular-kidney-metabolic (CKM) syndrome, according to findings from a recent National Health and Nutrition Examination Survey (NHANES) analysis.1

Results published in JAMA showed a notable proportion of those meeting CKM syndrome criteria were classified as having stages 3 or 4 and thus were at high risk of cardiovascular disease (CVD), with notable differences observed based on age, sex, and ethnicity.1

In 2023, a presidential advisory from the American Heart Association provided the first definition of CKM syndrome in an effort to redefine CVD risk, prevention, and management by recognizing the overlapping aspects of cardiovascular disease, kidney disease, type 2 diabetes, and obesity. However, little is known about the prevalence and temporal evolution of CKM syndrome stages in the US population.2

“Few studies have evaluated CKM syndrome stages in the US population; such data may inform health care design, research, training, and policy efforts,” Rahul Aggarwal, MD, physician and cardiology fellow at Brigham and Women's Hospital, Harvard Medical School, and colleagues wrote.1

To assess the prevalence and temporal evolution of CKM syndrome stages in a nationally representative sample of US adults, investigators leveraged data from the 2011-March 2020 NHANES dataset. Investigators pointed out that response rates decreased over the study period, from 69.5% in 2011-2012 to 46.9% in 2017-March 2020, with survey weights adjusted for nonresponse.1

Adults ≥ 20 years of age who underwent physical examination and fasting laboratory measurements were included in the present study. For each participant, investigators determined the CKM syndrome stage: stage 0 (no CKM risk factors, such as hypertension), 1 (excess or dysfunctional adiposity), 2 (additional metabolic risk factors or moderate- or high-risk chronic kidney disease), 3 (very high-risk chronic kidney disease or high predicted 10-year CVD risk), or 4 (established CVD, such as coronary artery disease).1

The final study population included 10,762 adult patients with a mean age of 47.3 (Standard deviation [SD], 17.0) years. Among the cohort, 51.8% of participants were female and 64.4% were White.1

Between 2011 and 2020, 10.6% (95% CI, 9.6%-11.6%) of US adults met criteria for CKM syndrome stage 0, 25.9% (95% CI, 24.6%-27.1%) for stage 1, 49.0% (95% CI, 47.4%-50.5%) for stage 2, 5.4% (95% CI, 5.1%-5.8%) for stage 3, and 9.2% (95% CI, 8.5%-9.8%) for stage 4. Investigators noted the prevalence of each stage did not change significantly over the study period (all P >.05).1

Upon analysis, adults ≥ 65 years of age were more likely to have advanced stages than were those 45 - 64 years of age (55.3% vs 10.7%; P <.001) and those 20 - 44 years of age (55.3% vs 2.1%; P <.001). For adults 20 - 44 years of age, investigators pointed out just 18.2% (95% CI, 16.5%-19.9%) had stage 0 CKM syndrome.1

Additionally, they noted that compared with women, men were more likely to have advanced stages (16.9% vs 12.4%; adjusted prevalence ratio [PR], 1.36; 95% CI, 1.24-1.49; P <.001). Similarly, by ethnicity, Black adults were significantly more likely to have advanced stages compared with White adults (18.9% vs 13.8%; adjusted PR, 1.38; 95% CI, 1.24-1.55; P <.001).1

Investigators outlined multiple limitations to these findings, including the use of self-report to establish CVD and the potential underestimation of stages 3 and 4 due to unavailable data on cardiac biomarkers, echocardiography, coronary angiography, cardiac computed tomography, atrial fibrillation, and peripheral artery disease.1

“Poor CKM health is widespread in the US population, especially among Black adults. Equitable health care approaches prioritizing CKM health are urgently needed,” investigators concluded.1


  1. Aggarwal R, Ostrominski JW, Vaduganathan M. Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2011-2020. JAMA. doi:10.1001/jama.2024.6892
  2. Campbell P. Kidney Week 2023: Evolving Recognition of Cardiovascular, Kidney, and Metabolic Disease. HCPLive. November 7, 2023. Accessed May 10, 2024.
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