It’s not every day that physicians coin a new name for a disorder — and that the disorder plagues a majority of Americans.

Last month, the American Heart Association and American College of Cardiology released guidelines for physicians on a syndrome it’s calling “CKM syndrome” or cardiovascular-kidney-metabolic syndrome, which they first dubbed a collection of disorders in 2023. It’s a revision of the formerly named “metabolic syndrome,” which experts say wasn’t specific enough to aid in detection and treatment.

The identification of CKM syndrome and the publication of the guidelines represent a reframing of how cardiologists, endocrinologists and other physicians want to catch and treat the early signs of metabolic illnesses to usher patients toward care more quickly and intentionally.

“This is revolutionary,” said Nikos Pappan, a cardiologist at St. Clair Health and the leader of the health system’s new Center for Cardiometabolic Prevention, which encompasses nutrition consultation, lifestyle changes and personalized medicine.

“It’s shifting the old thought of medicine.”

CKM syndrome can be thought of as a widening of the umbrella for a constellation of issues that crop up when the body struggles to process insulin, filter fluid through the kidneys and pump blood throughout the body.

“We are seeing for many years now a rise in metabolic conditions such as obesity and diabetes that are challenging to control, and gaining a better understanding of … how all these organ systems work together,” said Raghu Tadikamalla, a cardiologist at Allegheny Health Network.

Nearly 90% of U.S. adults have CKM, either at stage 1 or higher, per research published in the Journal of the American Medical Association in 2024. Grouping the conditions that make up the syndrome can help doctors approach patients more collaboratively, so that each risk factor isn’t siloed.

The AHA guidelines spell out distinct stages patients fit into. At stage 1, a patient may be completely asymptomatic but have excess fat around their waist, or slightly elevated A1C levels, which indicate how the body processes blood sugar. By stage 2, a patient might have high blood pressure, high cholesterol and be prediabetic but still be asymptomatic. At stage 3, damage to the heart, kidneys or blood vessels is starting to develop.

Before the term was coined and the stages delineated, a doctor might simply tell a patient in early stages to watch their diet or exercise more. They might say, “You have elevated A1C and are at risk for prediabetes — be mindful of your sugar consumption.”

The new terminology allows doctors to collect more information about patients' risk for heart and kidney disease, diabetes, stroke and heart failure, conduct additional lab tests and spend more time discussing lifestyle modifications.

“The guidelines really help us understand and promote collaborative care and aggressive care of these risk factors early,” said Anum Saeed, assistant professor of medicine at the University of Pittsburgh, cardiologist and lipidologist at UPMC and a member of the writing committee for the guidelines.

Greater awareness and early identification of these risk factors may prevent a patient from reaching the point of heart disease or heart failure at all, Tadikamalla said.

This shift to a systemic understanding of these organ systems — as opposed to a specialist approach — is also a result of advancing technology. As more and more Americans take glucagon-like-peptide medications (GLP-1s) to treat diabetes and obesity, doctors are gathering more data about how these drugs affect not just weight loss and insulin levels but the body on a larger scale.

Studies have shown GLP-1 drugs can reduce or eliminate cravings for drugs and alcohol by working on reward pathways in the brain, and researchers are exploring the drugs’ role in sleep apnea and Alzheimer’s disease.

Experts also pointed to a class of medications known as SGLT2 inhibitors that help the kidneys reabsorb glucose before it flows back into the blood stream. These advancements are reigniting a movement to view organ systems once thought of as hyperspecific and distinct as highly interconnected instead.

“Nowadays, with the newer medications we have available, it might be more helpful to see all of these as one creature,” said Tadikamalla. “This has been a trend in how people have been thinking and behaving for a little while now. Attitudes are evolving, and the guidelines are reflective of that.”

Ultimately, the goal is to move toward a healthcare system that is more collaborative, efficient and comprehensive — one that helps patients before problems become acute and life-threatening.

It’s a model Pappan is eager to cultivate at St. Clair. The health system has partnered with the Pittsburgh-based biotechnology company Lembas Health, which leverages artificial intelligence to create personalized nutrition consults, meal plans and frequent check-ins with the provider to integrate lifestyle modification in a meaningful way and reduce the time patients spend disengaged with their care.

“It’s very personalized and practical,” Pappan said. “It’s really to keep the patient engaged in their care plan, which is the core of our goal here.”

One might ask: Shouldn’t this approach be how medicine already works?

Absolutely, said Tadikamalla, and it’s what physicians strive for. But during a time of provider and nurse shortages and eroding trust in medical institutions, he hopes this reframing can shift health systems’ priorities back toward preventive and personalized care.

“The guidelines are kind of in the middle (of the spectrum),” he said, “where they're reflecting what some doctors are already doing and what some may do as a result (of the guidelines).”

It also triggers a more aggressive approach than what doctors might previously have done. The guidelines recommend that if a patient has a risk factor higher than 5%, for instance, blood labs are proactively drawn.

A future CKM clinic might have its own CKM coordinator that triages patients depending on their lab results and staging, someone “who knows the guidelines in and out, rather than being lost in the loop of prior authorization and wait times,” said Saeed.

UPMC doesn’t have its own CKM clinic now, but Saeed hopes to see that in the future.

“For us to have these cross-collaborative approaches can really be helpful,” she said. “They can be the landmark for our high-risk patients, to help them not progress to disease.”

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