The therapeutic approach to cardiovascular-kidney-metabolic syndrome.

Abstract

Obesity, type 2 diabetes mellitus and chronic kidney disease (CKD) are highly prevalent conditions that frequently coexist and result in an excess burden of cardiovascular disease (CVD), premature death and health-care resource utilization. The concept of cardiovascular-kidney-metabolic (CKM) syndrome highlights the overlap of pathophysiological mechanisms that underlie obesity, diabetes mellitus and CKD and, together with adverse socioecological factors, amplify CVD risk. This framework encourages a holistic approach that recognizes the interconnectedness between metabolic factors, CKD and CVD, and the importance of screening for these factors at a population level to identify windows for CVD prevention across the lifespan. CKD is a key risk factor, mediator and therapeutic target to reduce CVD burden. The approach to using guideline-directed medical therapies for CKM syndrome is facilitated by assessment of absolute risk using validated CVD calculators, enabling therapy to be tailored to match absolute risk for maximal net benefit. In addition, screening for adverse social drivers of health is necessary to identify structural barriers to optimal care and move towards a multidisciplinary approach to ensure alignment between healthy lifestyle, risk factor control and guideline-directed medical therapies for all individuals living with CKM syndrome.