A new scientific study published in Circulation: Population Health and Outcomes, a peer-reviewed journal of the American Heart Association, reveals that nearly 8 out of 10 young adults, average age 23, already have cardiovascular-kidney-metabolic (CKM) syndrome, and those with more advanced stages show early signs of arterial damage. The findings underscore the urgent need for cardiovascular disease prevention efforts to begin much earlier in life.
Investigators assessed the cardiovascular health of 1,283 participants from the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, a diverse cohort. They used two complementary tools: CKM syndrome staging and the American Heart Association's Life's Essential 8™ metrics. Ultrasound imaging of the carotid arteries revealed that participants in higher CKM stages had thicker artery walls, an early marker of atherosclerosis, even in their early 20s.
“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,” said study author Donald Lloyd-Jones, M.D., M.S., an American Heart Association volunteer and cardiologist at Boston Medical Center. He also serves as a professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine and is the principal investigator of the Framingham Heart Study.
CKM syndrome describes the interconnected relationship among obesity, diabetes, chronic kidney disease, and cardiovascular disease. It is categorized into stages from 0 (no risk factors) to 4 (existing cardiovascular conditions). In this study, nearly 80% of participants met criteria for stages 1 through 3, meaning they already had excess adiposity, metabolic risk factors, or subclinical cardiovascular disease. About 21% had no identifiable risk factors (stage 0), and none were in stage 4.
Participants with more advanced CKM stages also had lower Life's Essential 8 scores, which measure health behaviors and factors such as healthy eating, physical activity, tobacco avoidance, healthy sleep, healthy weight, and healthy cholesterol, blood sugar, and blood pressure levels. Life's Essential 8 is designed for measuring, monitoring, and improving cardiovascular health at any age, but especially in adolescents and young adults.
Current guidelines from the American Heart Association and American College of Cardiology recommend using the PREVENT™ equations to estimate 10- and 30-year cardiovascular risk, but those equations are validated only for adults aged 30-79. For younger adults, Lloyd-Jones recommends focusing on Life’s Essential 8 and optimizing as many metrics as possible. “For people in their 20s, we want to focus on improving cardiovascular health,” he said.
The study's limitations include its cross-sectional design, which cannot establish cause and effect, and the use of some self-reported data. Additionally, the study population intentionally included many individuals from disadvantaged backgrounds, so findings may not be generalizable to all young adults. However, the researchers concluded that the findings highlight the urgent need for prevention efforts to begin earlier in life, offering opportunities to improve cardiovascular health and prevent disease progression long before clinical disease appears.
This research adds to growing evidence that cardiovascular risk factors are present at younger ages than previously thought, and early intervention is critical to reducing the burden of heart disease, kidney disease, and metabolic disorders later in life.
