A new analysis published in Circulation: Population Health and Outcomes evaluated cardiovascular and metabolic health in a cohort of young adults and found high prevalence of early risk. Among 1,283 participants with an average age of 23 years, nearly 80% met criteria for cardiovascular-kidney-metabolic (CKM) syndrome stages 1–3, about 21% were stage 0, and none were stage 4. Participants classified in more advanced CKM stages also had poorer scores on the American Heart Association’s Life’s Essential 8 metrics and demonstrated early signs of arterial injury on carotid ultrasound, including increased carotid artery wall thickness, an early marker of atherosclerosis.
The report uses the CKM syndrome construct to describe the interconnected relationships among obesity, diabetes, chronic kidney disease and cardiovascular disease. CKM staging ranges from 0 (no identifiable risk factors) to 4 (established cardiovascular conditions such as coronary heart disease, heart failure or stroke). Stages 1–3 indicate increasing presence of excess adiposity, metabolic risk factors, and/or evidence of subclinical cardiovascular disease. In this young-adult sample, most participants met criteria for stages 1–3, signaling early clustering of cardiometabolic risks.
The American Heart Association’s Life’s Essential 8 framework combines health behaviors and health factors to measure and monitor cardiovascular health. The eight components are:
Investigators assessed participants’ cardiovascular health using both CKM staging and Life’s Essential 8 scores. The study reports that these two approaches are complementary: more advanced CKM stages correlated with lower Life’s Essential 8 scores, supporting use of Life’s Essential 8 as a practical tool to guide conversations and interventions with people in their 20s.
Researchers analyzed data from the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, a diverse cohort intentionally including many individuals from disadvantaged backgrounds. The analytic sample included 1,283 participants with a mean age of 23. The investigators staged CKM syndrome, calculated Life’s Essential 8 cardiovascular health scores, and evaluated carotid arteries with ultrasound imaging to detect early markers of arterial injury such as increased wall thickness.
The study found that higher CKM syndrome stages were associated with:
Taken together, these associations led authors to conclude that CKM staging and Life’s Essential 8 may help identify adults younger than 30 who are on a trajectory toward arterial injury, plaque accumulation, and higher risk for future cardiovascular events.
Authors emphasize the urgent need to begin cardiovascular prevention earlier in life. Because widely used risk calculators such as the PREVENT™ 10- and 30-year risk equations were developed and validated for people aged 30–79, they are not applicable to this younger population. The study team and commenting investigators recommend focusing clinical conversations on the Life’s Essential 8 framework in people in their 20s and optimizing as many of those metrics as possible to improve health now and reduce long-term risk. The findings suggest practical opportunities to intervene on lifestyle and risk factors well before clinical cardiovascular disease becomes apparent.
The authors report several limitations:
Because of these limitations, the authors state that additional longitudinal studies are needed to determine how CKM syndrome stage in young adulthood relates to longer-term cardiovascular disease risk and clinical outcomes.
The paper’s co-authors, disclosures and funding sources are listed in the published manuscript. The full article will be available online in Circulation: Population Health and Outcomes. The release references related American Heart Association resources on CKM syndrome, the CKM Health Initiative, Life’s Essential 8, and recent guideline materials on CKM and early risk conversations. The American Heart Association notes that statements and conclusions are those of the study authors and provides information about its funding and policies regarding potential conflicts of interest.