Linked health risks
Illustration by Jeffrey C. Chase | Photo by Ashley Barnas Larrimore July 07, 2025
UD analysis finds cardiovascular-kidney-metabolic syndrome rates rising across the US
One in three adults in the U.S. has three or more risk factors for a newly recognized but increasingly common condition: cardiovascular-kidney-metabolic (CKM) syndrome. First recognized by the American Heart Association (AHA) in a 2023 presidential advisory, CKM connects heart and metabolic health with kidney function as intertwined drivers of cardiovascular disease (CVD).
Long before CKM was defined, millions of Americans were unknowingly progressing through the condition’s dangerous stages.
In a first-of-its-kind analysis, Tarang Parekh, assistant professor of epidemiology at the University of Delaware College of Health Sciences, and colleagues at Houston Methodist Hospital and Harvard Medical School, examined the state-level prevalence of CKM syndrome, using self-reported data from the Centers for Disease Control’s Behavioral Risk Factors Surveillance System from 2011 to 2023.
Parekh’s analysis, recently published in the journal JAAC: Advances, found that 80% of the population has some form of CKM syndrome. Over the past 12 years, not a single state saw a decline in CKM rates.
West Virginia had the highest prevalence, with nearly 87% of residents affected by 2023. Delaware wasn’t far behind, with rates climbing from 76% to 83% over the same period. Colorado reported the lowest rate, with nearly 72% of the population impacted. Overall, CKM rates were highest in the Midwest and the South.
“This is an alarming trend that’s a result of our fragmented healthcare system,” Parekh said.
CKM, like many chronic diseases, progresses in stages. Stage zero means no disease is present. At Stage 1, individuals are obese or prediabetic. Stages 2 and 3 involve kidney disease, hypertension, high cholesterol, diabetes or a combination of risk factors that dramatically raise their risk for CVD. Stage 4 is dire.
“That’s where we see a clinical CVD diagnosis, including heart failure, stroke or coronary heart disease, or kidney failure,” said Parekh.
Parekh’s analysis found nearly 50% of states saw an increased prevalence of CKM in stages 1 through 3. While Stage 4 rates declined steadily nationwide, Minnesota was an exception, seeing significant increases in the most dangerous stage of the condition.
Stopping disease progression
Routine health screenings are key to slowing the progression of CKM and reducing CVD. However, work to get physicians to assess these conditions in an interconnected manner is only just beginning.
“We must educate the public about the intersection of these conditions, so they realize CKM syndrome is more than just taking care of obesity, diabetes, or CVD in isolation,” said Parekh. “Without lifestyle and behavioral changes, one risk factor can snowball into several.”
Significant variation in state-level programs also complicates the matter.
“Some programs only tackle diabetes self-management. We must expand those programs to include other risk factors for CVD to reduce CKM syndrome progression,” Parekh added.
Parekh also emphasized that individuals must take charge of their health.
“People need to know their weight, blood pressure, and BMI,” said Parekh. “Routine point-of-care testing during wellness visits is essential. But often, if a measure is borderline, we tend to ignore it — that needs to stop.”
A new initiative
To combat rising CKM rates, the AHA has launched a pilot preventive health initiative focused on improving care for people in select cities and regions, including Atlanta, San Diego, Baton Rouge, Louisiana, Washington, D.C, Maryland, and Ohio, including the Cincinnati metro area and parts of Kentucky. These locations were selected due to disease prevalence, health system infrastructure and community characteristics.
The AHA plans to expand the CKM Health Initiative to 15 geographic regions nationwide, ultimately reaching 250,000 Americans at 150 existing healthcare sites.
“The pilot brings together providers across various specialties, from primary care physicians to cardiologists and nephrologists, to take a more holistic approach to care,” Parekh said.
Looking ahead, Parekh plans to analyze clinical data using electronic health records (EHRs) to conduct a more detailed understanding of CKM. He also hopes to develop a machine-learning risk model to predict and, ultimately, slow CKM progression.
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