Tackling CKM Syndrome as a Holistic Approach to a Growing Health Crisis

A holistic approach, including lifestyle interventions and pharmacological treatments, and a team-based approach involving health care professionals, community members, and patients is needed to manage the increasing burden of cardiovascular-kidney-metabolic (CKM) syndrome, said Keith Ferdinand, MD, professor of medicine and the Gerald S. Berenson Chair in Preventative Cardiology, Tulane University School of Medicine.

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 give an overview of CKM, and can you elaborate on why the term was chosen to describe this interconnected condition?

We've chosen the term cardiovascular-kidney-metabolic syndrome, or CKM, to describe a health disorder that's attributable to various conditions, including obesity, diabetes, chronic kidney disease, and cardiovascular disease, that tend to cluster together and can then lead to heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral arterial disease. Much of this is based on the American Heart Association definition of the CKM. Alternative types of nomenclature have been used, but we're going to use CKM today.

Could you explain the mechanisms by which excess or dysfunctional fat tissue contributes to inflammation and damage in cardiovascular, renal, and metabolic systems?

The cardiovascular-kidney-metabolic syndrome arises through an interconnection of metabolic conditions, chronic kidney disease, and cardiovascular dysfunction. Underlying this process is adipose tissue, especially adipose tissue centrally. It causes inflammation with growth of the fat cells, apoptosis, and release of certain cytokines, including interleukin-6, as measured by an increase in this cytokine, and indirectly, through HSCRP, high-sensitivity C-reactive protein.

The fatty cells therefore release these cytokines and can inflame the cardiac muscle and vasculature, and may even increase the risk for chronic kidney disease independently. We now know that inflammation, therefore, may be one of the key pathways to cardiac disease in the CKM syndrome.

What strategies do you suggest for effectively integrating social determinants of health into routine screening and risk assessment for CKM syndrome?

Social determinants of health are a key determinant of the incidents and outcomes of CKM syndrome. This is a term that basically recognizes that where people work, live, play, and pray can have a profound impact on cardiovascular disease and other associated conditions. There are societal factors, such as social needs, the economy, the ability to access health care, their community factors, the built environment, zip code analysis, where people live, and relationships between their neighbors and other members of the community. These all impact the ability to access healthy foods; avoid fast foods, saturated fats, and fried foods; and can then lead to the cardiometabolic syndrome or cardiovascular kidney metabolic syndrome.

Looking at the social determinants of health, future risk factor determinations will take into account not only the traditional risk factors, but also the social factors, including zip code analysis. The new PREVENT calculator looks not only at things that we conventionally measure—age, blood pressure, presence or absence, of diabetes, lipids—but also looks at the social determinants of health in something known as the SDI Index [Social Deprivation Index] based on the zip code.

The zip code analysis, in other ways, is a way of determining the social determinant of health and the impact of where people work, live, play and pray, on outcomes related to CKM syndrome.