A new scientific study published in the American Heart Association's journal Circulation: Population Health and Outcomes has found that nearly 8 out of 10 young adults, with an average age of 23, already have cardiovascular-kidney-metabolic syndrome (CKM syndrome) stages 1-3. The research, which assessed 1,283 participants from the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, revealed that those in higher CKM syndrome stages showed early signs of arterial injury, including thicker carotid artery walls, an early marker of atherosclerosis.
CKM syndrome describes the interconnected relationship among obesity, diabetes, chronic kidney disease, and cardiovascular disease. It is categorized into stages from 0 (no risk factors) to 4 (existing cardiovascular conditions). The study found that about 21% of participants had no identifiable CKM risk factors (Stage 0), while nearly 80% met criteria for stages 1, 2, or 3, meaning they already had excess adiposity, metabolic risk factors, or evidence of subclinical cardiovascular disease. None were in stage 4.
In addition to CKM staging, investigators measured participants' cardiovascular health using the American Heart Association's Life's Essential 8 metrics, which include healthy eating, physical activity, avoiding tobacco, healthy sleep, healthy weight, healthy cholesterol, healthy blood sugar, and healthy blood pressure. They found that young adults with more advanced CKM syndrome stages had poorer Life's Essential 8 scores, and that more advanced stages were associated with early arterial injury.
“The study shows that CKM syndrome staging and Life’s Essential 8 are complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury, plaque build-up and, ultimately, at higher risk for future cardiovascular events,” said study author Donald Lloyd-Jones, M.D., M.S., an American Heart Association volunteer and cardiologist at Boston Medical Center.
Current guidelines from the American Heart Association and American College of Cardiology recommend using the PREVENT™ equations to estimate 10- and 30-year cardiovascular disease risk, but these equations were developed for people aged 30-79, so they are not applicable to the young adults in this study. Lloyd-Jones emphasized the importance of focusing on Life's Essential 8 metrics for improving cardiovascular health in people in their 20s.
“For people in their 20s, we want to focus on improving cardiovascular health,” Lloyd-Jones said. “The Life’s Essential 8 framework is designed for measuring, monitoring, and improving cardiovascular health at any age, but especially in adolescents and young adults.”
The study's findings highlight the urgent need for prevention efforts to begin earlier in life. “The findings highlight the urgent need for prevention efforts to begin earlier in life, suggesting there are opportunities to improve cardiovascular health and prevent disease progression long before cardiovascular disease becomes clinically apparent,” the researchers concluded.
However, the study has limitations, including its cross-sectional design, which shows association but cannot establish cause and effect, and the use of some self-reported health behavior data. Additionally, because the study population intentionally included many individuals from disadvantaged backgrounds, the findings may not be generalizable to all young adults. Additional long-term studies are needed to determine how CKM syndrome stage in young adulthood relates to future cardiovascular disease risk.
Lloyd-Jones recommends that conversations with young adults focus on optimizing Life's Essential 8 metrics for better health today and long term. “In my practice, and what I would recommend, is that the conversation focuses on Life’s Essential 8 and optimizing as many of those metrics as possible for better health today and long term,” he said.
This study underscores the importance of early cardiovascular risk assessment and lifestyle interventions in young adults to prevent future heart disease, kidney disease, and metabolic disorders.
