Understanding Cardiovascular-Kidney-Metabolic Syndrome (CKMS)
Cardiovascular-Kidney-Metabolic Syndrome, commonly abbreviated as CKMS and also referred to as CKM syndrome, represents a unified health framework introduced by the American Heart Association in 2023. This syndrome encapsulates the interconnected risks and progression of cardiovascular disease, chronic kidney disease, type 2 diabetes, and metabolic disorders like obesity. At its core, CKMS highlights how these conditions exacerbate one another, creating a vicious cycle that heightens the likelihood of heart attacks, strokes, heart failure, and premature death.
The syndrome is staged from 0 to 4 based on accumulating risk factors and clinical manifestations:
- Stage 0: No apparent risk factors, ideal cardiovascular-kidney-metabolic health.
- Stage 1: Presence of overweight or obesity, unhealthy behaviors (e.g., poor diet, inactivity), prediabetes, family history, or elevated lipids.
- Stage 2: Diagnosed type 2 diabetes, chronic kidney disease stages 1-2, persistent hypertension, or metabolic dysfunction-associated steatotic liver disease.
- Stage 3: Multiple high-risk conditions like chronic kidney disease stage 3+, subclinical cardiovascular disease, or heart failure.
- Stage 4: The most severe, defined by clinical cardiovascular disease combined with type 2 diabetes or chronic kidney disease stage 3+, or obesity with both.
These stages underscore a progressive deterioration, where early intervention can halt advancement. Recent national surveys indicate nearly 90% of U.S. adults fall into stage 1 or higher, signaling a public health crisis.
Augusta University's Groundbreaking BRFSS Analysis
Researchers at Augusta University, a leader in cardiovascular-kidney-metabolic health studies, have published pivotal new data illuminating CKMS distribution across the U.S. population. The study, titled "The Prevalence of Cardiovascular–Kidney–Metabolic Syndrome: A Review of Published Estimates and New Findings from BRFSS Surveys," appeared in Cardiovascular Medicine on February 3, 2026. Led by Steven S. Coughlin, PhD, from the School of Public Health's Department of Biostatistics, Data Science, and Epidemiology, the team included Biplab Datta, PhD, Marlo Vernon, PhD, Jennifer Sullivan, PhD, and medical students Nikul Parikh and Ashley Oh.
This work builds on Augusta University's American Heart Association-funded Strategically Focused Research Network (SFRN) center, which received $4.4 million as part of a $15 million initiative targeting CKMS heterogeneity in women. The university's expertise spans epidemiology, physiology, and public health, positioning it at the forefront of addressing Georgia's high obesity rates and national disparities.
The analysis reviewed prior estimates while generating fresh insights from the Behavioral Risk Factor Surveillance System (BRFSS), pooling data from 995,344 adults across 2019, 2021, and 2023 surveys. This large-scale approach enabled granular breakdowns by birth decade, sex, race/ethnicity, education, income, and rurality—offering unprecedented life-course perspectives on CKMS burden.
Key Prevalence Statistics: A Nationwide Snapshot
Age-adjusted U.S. prevalence reveals a stark reality: stage 0 (healthy) at 13.6%, stage 1 at 29.9%, stage 2 at 43.7%, stage 3 at 4.7%, and stage 4 (advanced) at 8.1%. Cumulatively, over 50% exhibit moderate-to-advanced disease, aligning with JAMA findings that nearly 90% meet stage 1+ criteria, unchanged from 2011-2023.
| CKMS Stage | Prevalence (%) |
|---|---|
| 0 | 13.6 |
| 1 | 29.9 |
| 2 | 43.7 |
| 3 | 4.7 |
| 4 | 8.1 |
BRFSS data underscores the syndrome's ubiquity, with advanced stages driving mortality—CKMS-attributable deaths reached millions from 2020-2023 alone.
Birth Cohort Trends: Older Generations Hit Hardest
The Augusta study dissects prevalence by birth decade, revealing a clear gradient: stage 4 peaks at 25.10% for those born before 1940, 22.81% in the 1940s, dropping sharply to 2.14% (1980s), 1.03% (1990s), and 0.55% (2000+). This pattern reflects cumulative lifetime exposures to poor diet, sedentary lifestyles, and socioeconomic stressors.
| Birth Decade | Stage 4 Prevalence (%) |
|---|---|
| ≤1939 | 25.10 |
| 1940s | 22.81 |
| 1950s | 14.85 |
| 1960s | 9.78 |
| 1970s | 5.04 |
| 1980s | 2.14 |
| 1990s | 1.03 |
| ≥2000 | 0.55 |
"The study highlights the very high prevalence of CKMS in the adult U.S. population, especially among older cohorts," notes lead author Steven Coughlin.
Racial and Ethnic Disparities in CKMS Burden
Racial inequities amplify risks: Among 1940s-1990s births, non-Hispanic Black adults exhibit significantly higher stage 4 prevalence than non-Hispanic Whites (e.g., 1950s: Blacks 17.45% vs. Whites 14.49%). Hispanics often exceed Whites in mid-cohorts, while Asians show lower rates. Coughlin emphasizes, "Black or African American adults born between the 1950s and 1990s have a particularly high prevalence of CKMS, which is an important observation for future studies."
These gaps stem from structural factors like access to care, nutrition deserts, and historical inequities, underscoring the need for targeted interventions. For insights into faculty researching health disparities, check Rate My Professor.
Sex Differences and Lifespan Variations
Males dominate advanced CKMS in pre-1980s cohorts (e.g., ≤1939: males 30.89% vs. females 21.14%), consistent with NHANES trends. Post-1980s, differences diminish, possibly due to evolving lifestyles. Yet, women face unique risks during pregnancy and menopause, a focus of Augusta’s SFRN center exploring obesity's role in cardiorenal metabolism.
This aligns with AHA data showing no overall improvement in stages over time, urging sex-specific strategies. Interested in epidemiology careers? Visit higher-ed-jobs/research-jobs.
Socioeconomic and Geographic Influences
CKMS stage 4 surges among non-college graduates, low-income households (<200% federal poverty level), and rural residents across decades. Rural-urban divides reflect limited healthcare access and higher obesity rates. Co-author Biplab Datta notes, "This study provides estimates... to better understand the differential burden."
Addressing these requires policy shifts, like expanding telehealth and nutrition programs in underserved areas. Higher-ed-career-advice offers tips for public health professionals tackling such challenges.
Comparing to Prior Research and Global Context
Prior NHANES analyses (e.g., JAMA 2024) pegged stage 1+ at ~90%, stage 3-4 at 15%, mirroring BRFSS. No temporal decline 2011-2023 signals stalled progress. Internationally, South Korea reports rising stage 4 (APC +3.2%). Augusta’s work fills gaps in cohort-specific data, complementing AHA surveys where only 12% recognize CKMS despite ubiquity.
For the full paper, see mdpi.com/1664-204X/29/1/5. More on AHA definitions: heart.org.
Public Health Implications and Mortality Risks
CKMS drives substantial mortality: 2020-2023 saw millions of attributable deaths, with trends rising. Advanced stages predict premature death, shortened life expectancy. Disparities exacerbate inequities, straining healthcare systems amid aging populations.
Augusta’s SFRN emphasizes prevention, integrating basic science (e.g., fatty acid metabolism) with epidemiology to inform interventions. Read the full announcement.
Prevention Strategies and Actionable Insights
Halting CKMS progression demands lifestyle shifts: balanced diet, regular exercise (150 min/week moderate), weight management, blood pressure/glucose screening. For stage 1, focus behaviors; stages 2+ require meds like SGLT2 inhibitors, GLP-1 agonists showing cardiorenal protection.
- Maintain BMI <25; waist <35in women/<40in men.
- Monitor A1C, eGFR, lipids annually post-40.
- Prioritize rural outreach, equity programs.
Professionals in preventive medicine can lead; explore clinical-research-jobs.
Future Research and Augusta University's Vision
Augusta eyes CKMS in women via SFRN projects on obesity-pregnancy links, aging mechanisms. Coughlin calls for life-course prevention studies. With $15M AHA backing, the university trains postdocs, fostering interdisciplinary talent.
Prospective careers? Faculty positions and postdoc opportunities abound in epidemiology. Stay informed via professor-salaries.
Conclusion: Time for Collective Action
The Augusta University study spotlights CKMS as a pervasive threat, disproportionately burdening older, Black, male, rural, and low-SES Americans. Yet, with awareness and targeted efforts, progression is preventable. Universities like Augusta exemplify higher ed's role in translational research.
Engage with experts on Rate My Professor, pursue higher-ed-jobs in public health, or access higher-ed-career-advice. Discover openings at university-jobs or post-a-job.