What you need to know about CKM, the link between heart health, diabetes and kidney disease

Heart disease, diabetes, and kidney disease are among the most common chronic illnesses in the United States – and they are all closely linked.

Adults with diabetes are twice as likely to have heart disease or stroke as those without diabetes. People with diabetes – type 1 and type 2 – are also at risk of developing kidney disease. And when the kidneys aren’t working well, a person’s heart has to work even harder to pump blood, which can then lead to heart disease.

The three diseases overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these conditions, or who are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show early signs of these related diseases.

While only 15% of Americans meet the criteria for advanced stages of CKM syndrome, meaning they have been diagnosed with diabetes, heart or kidney disease or are at high risk of developing them, the numbers remain “Astronomically higher than expected,” said Dr. Rahul Aggarwal, a cardiology researcher at Brigham and Women’s Hospital in Boston and co-author of the study.

Research suggests that people should pay attention early on to common risk factors for these diseases, including excess body fat, uncontrolled blood sugar, high blood pressure, and high cholesterol or triglyceride levels.

A dangerous cycle

Your kidneys, heart, and metabolic system (which helps turn the food you eat into energy and maintain your blood sugar levels) work closely together. If something goes wrong with one, it can lead to problems with the others.

One of the most important early changes in people who develop type 2 diabetes is insulin resistance, which occurs when your body doesn’t respond to insulin after meals as it should. This causes an increase in blood sugar levels.

Over time, high blood sugar narrows and stiffens blood vessels. This means the heart has to work harder: blood pressure rises to help blood cells and nutrients pass through tight, inflexible vessels. (People with type 1 diabetes, whose bodies don’t produce enough insulin, may also suffer if their blood sugar levels are poorly controlled.)

This high blood pressure is like kerosene on fire. This triggers inflammation in the body, said Dr. Chiti Parikh, executive director of integrative health and wellness at Weill Cornell Medicine in New York. This inflammation, combined with insulin resistance, increases levels of triglycerides and LDL cholesterol, which contribute to plaque buildup in blood vessels. Eventually, the plaque can rupture and cause a heart attack or stroke.

All of these factors – high blood pressure, uncontrolled blood sugar, and high triglycerides and LDL cholesterol – also take a toll on the kidneys. They can reduce blood flow to the kidneys and cause scarring of the cells that filter our blood. And when the kidneys stop filtering blood as well as they should, it causes imbalances in the amount of fluid, hormones, acids and salt in the body, said Dr. Kumar Sharma, director of the University of Texas Center for Precision Medicine and Nephrology. Health in San Antonio. This leads to more inflammation and cardiovascular problems and makes it more difficult to control blood sugar levels.

Although blood sugar problems often trigger this dangerous cycle, Dr. Parikh said, excess body fat, inflammation, high cholesterol and other risk factors can also cause changes that can lead to heart disease or renal or downstream diabetes.

Prevent progression

Preventing or managing any of these risk factors can help treat or reduce the risk of diabetes, kidney disease, or heart problems.

During annual wellness visits, your healthcare provider should check your blood pressure and may order blood tests that measure your glucose, cholesterol, and triglyceride levels. A doctor can also assess your kidney health by measuring protein in your urine or creatinine in your blood. Another blood test can measure C-reactive protein, which can indicate the presence of inflammation, Dr. Parikh said.

Once you have an idea of ​​your overall health, look for areas where you can start to make meaningful changes. Adding more fiber, fruits, and vegetables to your diet can help regulate blood sugar and reduce blood pressure. Increasing muscle mass through strength training has been shown to help combat insulin resistance. And any type of movement can be beneficial for managing your blood sugar and blood pressure. Experts recommend aiming for 150 minutes of exercise each week.

“Don’t think in terms of all or nothing,” said Dr. Estrelita Dixon, an internal medicine specialist at UC Health in Cincinnati.

In some cases, you may need medications to help manage high blood sugar, high blood pressure, or high cholesterol. There is growing evidence that certain diabetes medications, including newer drugs like Ozempic and older SGLT2 inhibitors, may also help with kidney disease and cardiovascular disease.

They may be different conditions, doctors say, but a comprehensive approach to diabetes, heart and kidney disease could help prevent serious complications in the future.