Most Urban Youth Already on Bad Path by Cardiovascular-Kidney-Metabolic Standards

The relatively new concept of cardiovascular-kidney-metabolic (CKM) staging got further validation for young adults, based on a study in an urban population.

Among FF-CHAYA study participants followed from birth, the cardiovascular health scores in their early 20s fell in line with CKM staging (P<0.001). Scores on Life’s Essential 8 averaged 77.6 in stage 0 (no risk factors), 70.0 in stage 1 CKM (excess adiposity), 63.8 in stage 2 CKM (metabolic risk factors), and 64.4 in stage 3 CKM (subclinical cardiovascular disease or advanced kidney disease).

In addition, CKM stages corresponded to early markers of carotid arterial injury in young adulthood. CKM stages 1-3 were associated with significantly higher mean-maximum carotid intima-medial thicknesses compared with stage 0, for instance, 0.014 mm thicker for stage 1, 0.020 mm thicker for stage 2, and 0.100 mm thicker for stage 3, reported Donald Lloyd-Jones, MD, ScM, of Boston University Chobanian & Avedisian School of Medicine, and colleagues in Circulation: Population Health and Outcomes.

“These findings provide validation of the novel construct of CKM syndrome in a demographically diverse sample of young adults and have important implications for CVD [cardiovascular disease] prevention,” they wrote.

“Our findings underscore the urgency of earlier prevention and population-level efforts to address the upstream drivers of CKM health. Future work should evaluate the application of the CKM stages in clinical practice among younger adults to support risk stratification and preventive efforts,” they concluded.

Staging for CKM syndrome is already strongly endorsed in all youths and adults alike since the release of the American CKM guideline that recently replaced older overweight and obesity recommendations.

The CKM framework was introduced by the American Heart Association (AHA) as a way to describe a wide-ranging health disorder related to complex interplay between heart disease, kidney disease, diabetes, and obesity.

Nearly 90% of U.S. adults are said to have at least one CKM syndrome risk factor. To describe these risks, clinicians have Life’s Essential 8, a health scale from 1-100 points covering dietary quality, physical activity, sleep, nicotine exposure, body mass index (BMI), blood glycemia, blood lipids, and blood pressure.

According to the CKM guideline, adults in CKM stage 0 are advised to have lipids, glycemia, and kidney function assessed at least every 5 years to ensure timely identification of CKM syndrome risk factors for optimal CVD prevention. Recommended monitoring frequency increases to at least once every 2-3 years in CKM stage 1, and once a year in CKM stage 2-3.

Risk factors continue to increase in prevalence in the U.S. Obesity alone is estimated to affect up to 60% of young adults age 20-44 by the year 2050.

In the present study, FF-CHAYA cohort participants were categorized as 20.7% in CKM stage 0, 40.2% in CKM stage 1, 36.2% in CKM stage 2, and 2.8% in CKM stage 3 at around age 22.

BMI, glucose, lipids, and blood pressure scores were significantly higher (better) in stage 0 and lower (worse) in more advanced CKM stages (P<0.01). Meanwhile, there was no such trend for the behavior-related domains (i.e., dietary quality, physical activity, sleep, and nicotine exposure).

“[T]his may reflect the limited sensitivity of self-reported data for describing these metrics in our study, and the importance of diet, physical activity, smoking cessation, and sleep is well established. Health behaviors are further upstream in the causal pathway for arterial injury and likely require longer than proximal physiological risk factors to manifest associations with subclinical CVD,” Lloyd-Jones’ group suggested.

“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,” stressed Lloyd-Jones in a press release.

“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,” said Lloyd-Jones, a former volunteer president of the AHA.

FF-CHAYA is an ancillary study of the Future of Families and Child Well-Being Study that enrolled around 5,000 mother-baby dyads. Enrollment took place at the time of birth from 1998-2000 in 20 large U.S. cities, with investigators oversampling for single mothers to boost the representation of people from disadvantaged backgrounds.

The present work included the 1,283 participants who had an in-person examination and responded to a health questionnaire in their early 20s. Mean age was 22.9 years, 54.4% were women, 51.6% identified as Black, and 27.1% as Hispanic. Just over half had a history of parental incarceration.

FF-CHAYA was acknowledged as having limited generalizability to other groups of young adults with different demographic compositions. Additionally, longitudinal data are needed among young adults, according to study authors.