Almost 80% of young adults were found to have risk factors for cardiovascular-kidney-metabolic (CKM) syndrome by age 23 in a new study, indicating excess adiposity, metabolic risk, and, in some cases, signs of subclinical cardiovascular disease.

The findings raise concerns about the possibility of CKM going undetected for years and reiterate the importance of early screening for the condition, the authors said.

“We were surprised that only 20% of these young adults had heathy weight, healthy fat distribution, normal kidney function, and no metabolic risk factors,” said Donald Lloyd-Jones, MD, co-author of the study and a cardiologist at Framingham Center for Population and Prevention Science at Boston University Chobanian & Avedisian School of Medicine in Boston.

Recognizing that adverse adiposity, metabolic and kidney disease, and heart disease are all connected, the American Heart Association (AHA) in 2023 introduced the CKM syndrome staging framework. Stage 0 represents no risk factors, while stages 1 through 4 indicate an increasing presence of risk factors and disease. The CKM staging framework also provides stage-specific recommendations for preventing and treating these conditions.

The study’s findings were published in Circulation: Population Health and Outcomes.

An Accelerated Track

Lloyd-Jones and colleagues observed significant differences in the measures of early arterial injury already occurring, indicating young adults are on an accelerated track to developing plaque and ultimately being at higher risk for heart attack and stroke.

“The more risk factors these young adults had, the greater the degree of arterial injury on average,” he said.

Lead author Vaishnavi Krishnan said the team was trying to understand the distribution of CKM stages.

“We also wanted to learn whether CKM stages were associated with evidence of early arterial injury, which is an indicator of underlying disease in its early stages,” said Krishnan, a third-year medical student at Boston University Chobanian & Avedisian School of Medicine.

The FF‐CHAYA study used the AHA framework for CKM stages. Of 1283 young adults (mean age, 23 years) participating in the study, 20.7% were classified as stage 0, 40.2% as stage 1, 36.2% as stage 2, and 2.8% as stage 3. No one was classified as stage 4.

The team also analyzed dietary habits, physical activity, sleep, nicotine exposure, BMI, blood lipids, blood glycemia, and blood pressure.

“Our findings reflect a substantial burden of risk factors already present in this population and is consistent with nationally representative data and the growing prevalence of heart disease risk factors observed among younger adults,” Krishnan said. “They suggest that early disease may be developing silently during young adulthood, especially in the presence of more advanced CKM stages.”

Disease Developing Silently

The study underscores the urgency for more cardiovascular disease prevention efforts during young adulthood, as early action is important for optimizing long-term health, Krishnan noted.

Jaideep Patel, MD, a cardiologist at Johns Hopkins Medicine in Baltimore, added that the presence of early structural arterial alterations in young adulthood is a predictor of future atherosclerotic cardiovascular disease.

“CKM screening during young adulthood provides a vital opportunity for primary and primordial prevention,” said Patel, who was not involved with the study.

“Young adults with significant metabolic and subclinical cardiovascular risks frequently go underdiagnosed and undertreated,” Patel said. “CKM screening identifies early-stage risk that allows clinicians to target root drivers before permanent arterial remodeling occurs.”

Lloyd-Jones concluded that across all CKM stages, promotion of cardiovascular health using the Life’s Essential 8 score, a measurement tool that Lloyd-Jones helped develop when he was the AHA’s president.

“Focusing on healthy behaviors like physical activity and healthy eating and supporting patients in achieving healthy levels of blood pressure, blood sugar, and cholesterol is particularly useful for younger individuals,” he said. “They have the opportunity to build and maintain better health early, control or reverse any early adverse findings, and avoid developing chronic illnesses.”

Lloyd-Jones reported serving as an unpaid fiduciary director of the American Heart Association. Krishnan and Patel reported no financial disclosures.

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