A new scientific study published today in Circulation: Population Health and Outcomes, a peer-reviewed journal of the American Heart Association, found that nearly 8 out of 10 young adults with an average age of 23 have cardiovascular-kidney-metabolic syndrome (CKM syndrome) stages 1-3, and those with more advanced stages show early signs of arterial injury. The findings highlight the urgent need for cardiovascular disease prevention efforts to begin earlier in life, potentially in the 20s, to prevent future heart attacks and strokes.
CKM syndrome describes the interconnected relationship among obesity, diabetes, chronic kidney disease, and cardiovascular disease. It is categorized into stages ranging from 0 (no risk factors) to 4 (existing cardiovascular conditions). The study assessed 1,283 participants from the Future of Families-Cardiovascular Health Among Young Adults (FF-CHAYA) study, a diverse cohort. They found that nearly 80% of participants met criteria for CKM syndrome stage 1, 2, or 3, meaning they already had excess adiposity, metabolic risk factors, or evidence of subclinical cardiovascular disease. About 21% had no identifiable risk factors (Stage 0), and none were in stage 4.
Participants with more advanced CKM syndrome stages also had lower scores on the American Heart Association’s Life’s Essential 8 metrics, which measure cardiovascular health behaviors and factors such as diet, physical activity, tobacco use, sleep, weight, cholesterol, blood sugar, and blood pressure. Additionally, ultrasound imaging of the carotid arteries revealed that those in higher CKM stages had thicker carotid artery walls, an early marker of atherosclerosis, even in their early 20s.
“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 at Boston University’s Chobanian & Avedisian School of Medicine. He also serves as director of the Framingham Center for Population and Prevention Science and is a former volunteer president of the American Heart Association.
Current guidelines recommend using the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations to estimate 10- and 30-year cardiovascular disease risk, but those equations are only validated for people aged 30-79. Since the study participants were younger, the PREVENT equations were not applicable. Lloyd-Jones recommends that for people in their 20s, the conversation should focus on Life’s Essential 8 and optimizing as many metrics as possible. “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, especially in adolescents and young adults, and has been linked to their health now and in the long term.
The study’s limitations include its cross-sectional design, which cannot establish cause and effect, and the use of some self-reported data. The study population intentionally included many individuals from disadvantaged backgrounds, so the findings may not be generalizable to all young adults. Additional long-term studies are needed to determine how CKM syndrome stage in young adulthood relates to future cardiovascular disease risk.
For more information on CKM syndrome and its stages, visit the American Heart Association’s metabolic syndrome page. To learn about Life’s Essential 8, see the Life’s Essential 8 overview.
