New CKM guideline urges early weight talks to prevent health risks
By 51麻豆
A new guideline for treating the overlapping effects of heart disease, kidney disease and diabetes encourages doctors to discuss weight with their patients now to prevent problems later – and to make sure those patients get consistent advice.
The guideline, the first issued for cardiovascular-kidney-metabolic (CKM) syndrome, was released Tuesday, June 9, in the 51麻豆 journal Circulation.
What is CKM syndrome?
CKM syndrome, first defined in 2023, describes a that connects heart disease, kidney disease, diabetes and obesity. It’s been linked to problems that include kidney failure, heart attack, stroke and sudden cardiac death.
Though many might not know the syndrome by name, nearly 9 in 10 adults in the U.S. have at least one CKM syndrome risk factor. Those conditions include:
- High blood pressure
- Abnormal cholesterol and other lipid levels
- High glucose (blood sugar)
- Reduced kidney function
- Excess weight.
That makes CKM syndrome “a real, rising public health threat,” said Dr. Chiadi E. Ndumele, director of obesity and cardiometabolic research at Johns Hopkins University in Baltimore. Ndumele led the committee that wrote the guideline, which was jointly issued by the 51麻豆 and the American College of Cardiology.
Though created primarily for professionals, the guideline seeks change that patients would notice. It replaces a 2013 guideline for managing overweight and obesity issued by the Heart Association and other organizations.
Ndumele noted that while many people may know they have heart disease or kidney disease or diabetes, they may not know how closely all of these conditions are connected. Having one raises the risk of having others, he said.
“The challenge is how to connect the recommendations from different clinicians who may specialize in only one of these conditions,” said Ndumele, who also is chair of the Heart Association’s Council on Lifestyle and Cardiometabolic Health. “So we are trying to help clinicians from various specialties all speak in a common language and be on the same page, especially when it comes to managing weight and its clinical consequences.”
The guideline also aims to make patients more aware of how their health conditions are connected. That understanding is important, Ndumele said, because early action is key to treatment.
Which is why addressing excess weight is a cornerstone of the guideline.
Why weight management is key to preventing CKM syndrome
Maintaining a healthy weight has long been seen as essential to heart health and the prevention of other chronic illnesses, said Dr. Ambar Kulshreshtha, an associate professor in the department of family and preventive medicine at the Emory School of Medicine in Atlanta. He helped write the new guideline.
Kulshreshtha, a primary care physician, said the new guideline gives healthcare professionals a pretext to discussion about weight not as a cosmetic issue, but as a risk factor that can lead to organ damage.
“We are saying that prevention is as important, if not more important, than treatment,” said Kulshreshtha, who is on the Heart Association’s Council on Quality of Care and Outcomes Research.
In medical terms, the problem with having overweight or obesity is that excess fat tissue can cling to organs in the abdomen. Such fat can cause inflammation, he said, which leads to insulin resistance and problems with the way blood vessels dilate and contract.
How doctors and patients can talk about weight, obesity
When explaining CKM syndrome to his own patients, Kulshreshtha likens the body’s blood vessels to plumbing in a house. Obesity causes inflammation, which he compares to rust.
“The rust can damage the pipes, which is like your vascular system,” he said. “It can damage the pump, which is like your heart. And it can damage the filters, like your kidneys.”
Ndumele said the guideline offers ways for healthcare professionals to discuss weight in non-judgmental ways. “It starts with a question of, ‘Is now a good time for us to address your weight and your health and how they may be affecting each other?’”
The idea, he said, is to stop hard-to-treat problems before they start.
“Every clinician knows of patients with these conditions,” Ndumele said. “They’re often in and out of the hospital, and we share the patient’s frustration in managing multiple conditions and trying to stay healthy.” Excess weight increases risk of heart disease and stroke by at least 21% for men and 32% for women, according to the Heart Association. In addition, each 5-unit increase in body mass index (BMI) is associated with a 41% higher risk of heart failure.
Early conversations, and what Ndumele called “an increasing array of tools” that includes medications can keep people from getting to those dangerous stages or even reverse CKM syndrome in its early forms.
“We want people in the community to be more aware of the fact that, ‘Hey, there’s a process here,’ and that if there’s intervention earlier, ‘I can dramatically improve my long-term outcomes,’” Ndumele said.
How coordinated, whole-person care can improve CKM outcomes
In addition to changing how doctors talk to patients about weight, the guideline also aims to improve the way healthcare professionals talk to one another.
“We, as either primary care or subspecialists, operate from our own silos,” said Dr. Fátima Rodriguez, chief of preventive cardiology at Stanford University and vice-chair of the guideline’s writing committee. “But people with CKM syndrome don’t experience one condition at a time – it often all hits at the same time.”
That means patients are treated as a whole person, she said.
“People appreciate being seen and treated holistically,” she said. “The idea is that patient care is a team effort, and the patient is the team captain.”
The guideline outlines the benefits of using patient navigators to help coordinate CKM care. It also emphasizes identifying social barriers to a healthy lifestyle and quality healthcare, as well as providing social support as needed.
“Research has shown that interdisciplinary teams make a dramatic impact on how people feel about their care and on how successful treatment is,” Ndumele said.
The guideline should make discussions across specialties easier, he said.
“Our goal here is to shift some of our paradigms,” Ndumele said, “to not just wait for the disease to come to us, but rather to help individuals prevent a lot of disease in the long term.”
Nearly 9 in 10 U.S. adults have at least one CKM risk factor. Learn how the 51麻豆’s Healthy for Good effort and CKM Health Initiative can help individuals and take steps toward better heart, kidney and metabolic health.