A large study of young adults in the United States found that many already met criteria for early stages of cardiovascular-kidney-metabolic syndrome, a framework designed to capture interconnected cardiovascular, kidney and metabolic risks. More advanced stages were also associated with greater evidence of subclinical carotid artery changes, despite the participants’ young age.
The findings, published in Circulation: Cardiovascular Quality and Outcomes, suggest that cardiometabolic risk can become detectable well before the development of clinically apparent cardiovascular disease. They also highlight young adulthood as a potentially important period for identifying modifiable risk factors.
What the new study reveals
Researchers analyzed 1,283 young adults from an urban cohort using the cardiovascular-kidney-metabolic, or CKM, syndrome framework. Approximately 80 percent of participants met criteria for at least one stage of CKM syndrome.
Participants with more advanced CKM stages were more likely to show subclinical changes in the carotid arteries, the major blood vessels supplying the brain. These vascular abnormalities were detectable even though participants had not progressed to stage 4 CKM, which includes clinical cardiovascular disease.
Within the cohort, approximately 40 percent of participants were classified as stage 1 CKM, 36 percent as stage 2 and 2.8 percent as stage 3. The stages represent progressively greater combinations of metabolic risk factors, kidney abnormalities and cardiovascular risk.
The analysis found that increasing CKM stage was associated with a greater burden of subclinical carotid artery abnormalities. The results suggest that cardiovascular changes can accompany CKM risk relatively early in adulthood rather than appearing only after decades of established disease.
Earlier imaging of more than 1,000 young people in the cohort had also identified evidence of subclinical carotid artery abnormalities. Despite an average participant age of approximately 23, measurements of carotid artery structure raised concerns about vascular health at an unexpectedly young age.
However, describing these measurements as showing arteries literally equivalent to those of a 33-year-old should be interpreted cautiously. Carotid measurements can indicate subclinical vascular changes, but they do not provide a simple biological “arterial age” for an individual.
A framework connecting heart, kidney and metabolic health
The American Heart Association introduced the CKM syndrome framework in 2023 to emphasize the interconnected nature of cardiovascular disease, kidney disease and metabolic conditions.
Rather than treating these conditions as entirely separate problems, CKM staging is intended to identify how risk can develop and progress across multiple organ systems. Factors including excess or dysfunctional adiposity, abnormal glucose regulation, high blood pressure, abnormal blood lipids and kidney dysfunction can overlap and contribute to cardiovascular risk.
The framework ranges from stage 0, representing no CKM risk factors, through progressively higher-risk stages and ultimately stage 4, which includes clinical cardiovascular disease in the context of CKM syndrome.
This approach is particularly relevant to prevention because earlier stages may contain modifiable risk factors that can be addressed before clinically apparent cardiovascular disease develops.
Public familiarity with the term CKM syndrome, however, remains limited. Because the framework itself is relatively new, many people may recognize individual conditions such as hypertension, diabetes or kidney disease without recognizing them as components of an interconnected cardiovascular risk spectrum.
Lifestyle and cardiometabolic health
The researchers also examined cardiovascular health using the American Heart Association’s Life’s Essential 8 framework. It incorporates eight components: diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose and blood pressure.
Lower Life’s Essential 8 scores were associated with more advanced CKM stages and a greater burden of subclinical carotid artery abnormalities.
The study population included young adults from an urban cohort in which social and environmental factors may influence opportunities for healthy eating, physical activity and other health behaviors. These circumstances are important when interpreting lifestyle-related risk because individual behavior occurs within broader economic and environmental conditions.
The findings therefore should not be interpreted as showing that poor personal choices directly caused the vascular abnormalities observed in the participants. The study identified associations between cardiovascular health measures, CKM stages and subclinical vascular changes.
What early CKM risk means
Being classified in an early CKM stage does not mean that a young adult has cardiovascular disease or will inevitably develop a heart attack, stroke or kidney failure.
Instead, the staging system is intended partly to identify risk at a point when preventive interventions may still have substantial value. Factors such as blood pressure, blood lipids, glucose regulation, nicotine exposure, physical activity and body composition can change over time.
Lifestyle measures including regular physical activity, a nutritious dietary pattern, adequate sleep and avoiding nicotine are established components of cardiovascular prevention. Depending on an individual’s specific conditions and overall risk, clinicians may also use medications to manage hypertension, abnormal cholesterol, diabetes, obesity or kidney-related cardiovascular risk.
However, drugs such as statins, SGLT2 inhibitors or GLP-1 receptor agonists should not be interpreted as general treatments for any young person classified within the CKM spectrum. Their use depends on specific diagnoses, risk profiles, indications and clinical guidelines.
Why young adulthood may matter
The study adds to evidence that cardiovascular risk develops over time and that measurable abnormalities can emerge before people experience symptoms or clinical cardiovascular events.
Young adulthood may therefore represent an important period for prevention. Identifying elevated blood pressure, abnormal glucose or lipid levels, nicotine exposure and other modifiable factors earlier could provide more time to address them before cardiovascular and kidney disease become established.
At the same time, the findings do not demonstrate that lifestyle changes will necessarily reverse the specific carotid abnormalities detected in this cohort. Nor can the observational associations establish that a higher CKM stage directly caused the vascular changes.
The characteristics of the study population also matter when considering how broadly the results apply. Findings from an urban cohort with particular demographic and socioeconomic characteristics may not translate directly to all young adults in the United States or other countries.
Still, the high prevalence of early CKM stages in this group indicates that young age alone does not exclude the presence of meaningful cardiometabolic risk factors. The findings support greater attention to cardiovascular, metabolic and kidney health earlier in adulthood, while reinforcing the value of prevention before clinical disease develops.
