CKM Treatment Involves a Team-Based Approach, Says Dr Keith Ferdinand

In the second part of this interview, Keith Ferdinand, MD, professor of medicine and the Gerald S. Berenson Chair in Preventative Cardiology, Tulane University School of Medicine, shares new insights on cardiovascular-kidney-metabolic (CKM) syndrome, and its treatment landscape.

Ferdinand recently authored an article for The American Journal of Managed Care^® providing an overview of CKM syndrome. Learn more about management of CKM syndrome.

This transcript has been lightly edited.

Transcript

Can you discuss recent advancements in treatment, and how might new therapies change the standard of care?

The standard of care for CKM syndrome goes beyond simply measuring the traditional risk factors. We should screen for the social determinants of health, use some marker of central obesity—although the BMI is somewhat inaccurate— [and] also consider waist circumference. Note that BMI may vary based on race and ethnicity. In many populations of Asian descent, having obesity at 27 BMI vs 30, we then take into account measurement of certain subclinical risk factors, including urine albumin creatinine ratio, inflammatory markers such as HSCRP [high-sensitivity C-reactive protein], and other measures beyond the traditional risk factors.

Subsequently, it's necessary to screen for those traditional risk factors, acuity measured blood pressure, lipid levels, and dysglycemia. Once [the] disease becomes manifest, consider means of screening for subclinical disease, including echocardiography for left ventricular dysfunction and coronary calcium scoring.

Additionally, we now know that the CKM syndrome may actually be expanded beyond this axis and to involve the liver. What we previously called nonalcoholic steatohepatitis is now metabolic disease-associated liver disease, in which the patient can have steatohepatitis from fatty infiltration of the liver and lead to hepatic dysfunction, and in worst cases, hepatic failure. Therefore, it's a cluster throughout the body, not a silo, that explains these conditions

What are the biggest gaps in our current understanding of CKM syndrome, and what research areas do you believe should be prioritized?

Perhaps the biggest gap that we have is how to better get health care professionals, including physicians, subspecialists, and primary care clinicians to work together as a team. Even more importantly, expand that team beyond the clinicians themselves to include community members, community health workers, the patient, and the patient's family, along with other professionals who may not be directly prescribing, such as clinical pharmacists, nurses, nurse practitioners, or advanced practice nurses.

The team-based approach is perhaps going to be the linchpin for success going forward, we now have data with one study called COORDINATE (NCT03936660) that showed if we can give clinicians of various degrees of expertise to work together, not only with physicians, but other advanced practice nurses, nurse practitioners, clinical pharmacists, and with the community to educate and motivate everyone to work together, perhaps we can better address some of the underlying risk for the CKM syndrome.

Globally and especially in the United States, as the population ages, we're going to see more CKM syndrome, increased diabetes, physical inactivity, and central obesity.

Therefore, we can expect that we will need a multi-faceted, team-based approach to decrease this increasing tsunami of CKM syndrome and outcomes that will be expected to increase cardiovascular mortality. In fact, since the pandemic, cardiovascular mortality now does appear to increase, and if we don't effectively manage CKM syndrome with team-based care, we will never be able to curtail the upcoming tsunami. We as health care professionals, along with the community, the patients, the patients’ family, and other members who will all have an impact on the patient's outcomes, need to work together to better manage CKM syndrome.