For US adults with cardiovascular-kidney-metabolic (CKM) syndrome, risk factor control is lacking, especially for high-risk individuals, according to a new study.

Among adults with CKM syndrome, not only are treatment rates for hypertension and hyperlipidemia inadequate, but fewer than half of treated individuals also achieve glycemic or blood pressure control, said Rishi K. Wadhera, MD, associate director of the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston.

Wadhera was part of a team of researchers who examined national treatment rates for hypertension, diabetes, and hyperlipidemia for adults with CKM syndrome. They sought to determine risk factor control among treated individuals from 2015 through 2023. The study was published in the Journal of the American College of Cardiology.

Overall, nearly 90% of American adults show signs of stage I or higher CKM syndrome, and nearly 44% of youths aged 12-18 years have early stages of CKM syndrome.

Using participant data from the National Health and Nutrition Examination Survey 2015-2023, the team conducted a data analysis of 6384 adults with CKM syndrome stage II and above to evaluate rates of blood pressure, glycemic, and cholesterol control via age- and sex-adjusted analyses among individuals receiving treatment.

Although high blood pressure and high cholesterol are some of the most treatable conditions, the study found only about half of adults with hypertension or hyperlipidemia were being treated.

Not Getting Treatments to Patients

“Even among patients receiving treatment, fewer than half obtained blood pressure or glycemic control,” said Wadhera, who is also an associate professor at Harvard Medical School and Harvard T.H. Chan School of Public Health in Boston. “The problem isn’t a lack of effective treatments; it’s that we’re not getting treatments to patients who need them.”

The researchers also observed the widest gaps in care among younger adults, women, and Hispanic patients. This finding underscores the fact that certain groups are falling through cracks in the system, Wadhera noted. He added that gaps were prevalent among those with less insurance coverage and poor access to care, patients who are too often at the mercy of systemic inequities and language barriers.

Younger adults had the lowest treatment rates, which proves problematic, Wadhera said. “The cholesterol and blood pressure you carry in your 20s and 30s compound over decades. Undertreating young adults today sets up a wave of preventable heart disease tomorrow.”

Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, who co-authored an accompanying editorial with Josephine Harrington, MD, of the University of Colorado Medical School in Aurora, Colorado, said that the core message of the study is that the new CKM framework has done a good job establishing whom to treat, but the bottleneck has shifted.

“For the highest-risk patients, initiation is not the key challenge; it’s intensification,” he said. “From a clinical practice standpoint, there is a need for reorientation away from simply starting therapy to moving toward ensuring that patients actually reach their targets. That means relying on risk assessment, not just deciding who gets treated but to set how aggressively we titrate. It also means investing in the team-based and system-level structures that make sustained titration possible rather than expecting it to happen in a single clinic visit.”

Implementation Closes the Gaps

Wadhera added that the new CKM framework matters because it treats conditions such as hypertension and high cholesterol as interconnected conditions.

“However, a framework on paper doesn’t lower anyone’s blood pressure,” he said. “Guidelines are necessary, but they don’t execute themselves. What closes these gaps is implementation, a healthcare system that incentivizes screening and treatment, control of common risk factors, and care that meets patients where they are.”

Clinicians need to understand why patients at the highest cardiovascular risk had the worst blood pressure control, Wadhera continued. “That’s counterintuitive and points to a clinical inertia we need to address. We also need to figure out why the needle for glycemic control has barely moved despite a plethora of powerful new diabetes drugs.”

The innovation-implementation gap has never been wider in the US, Wadhera added. “The next frontier isn’t necessarily better drugs,” he said. “It’s effectively delivering the ones we already have to patients. And we need to connect with younger adults, who are largely disconnected from care at exactly the age when early intervention pays the biggest long-term dividends.”

Wadhera reported serving as a consultant for Chamber Cardio and Abbott, unrelated to the published work. Pandey reported receiving research support from the National Institute on Minority Health and Health Disparities; the National Heart, Lung, and Blood Institute; the American Heart Association; Ultromics; Anumana; scPharmaceuticals; SQ Innovation; AstraZeneca; and Roche Diagnostics. He also reported serving as a consultant for and/or receiving honoraria outside of this study as an advisor/consultant for a number of pharmaceutical companies.

Martta Kelly is a medical journalist who lives in the metropolitan New York area.