New research published today in Circulation: Population Health and Outcomes, a peer-reviewed journal of the American Heart Association, reveals that nearly 8 out of 10 young adults in their early 20s already have early signs of arterial injury associated with cardiovascular-kidney-metabolic (CKM) syndrome. The findings underscore the urgent need for cardiovascular disease prevention efforts to start much earlier in life.
The study, which analyzed data from 1,283 participants with an average age of 23, found that nearly 80% met criteria for CKM syndrome stages 1 through 3, meaning they had excess adiposity, metabolic risk factors, or subclinical cardiovascular disease. None were in stage 4, which indicates existing cardiovascular conditions. Participants with more advanced CKM syndrome stages also had poorer scores on the American Heart Association's Life's Essential 8 metrics, which measure key health behaviors and factors.
“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, cardiologist at Boston Medical Center, and professor at Boston University’s Chobanian & Avedisian School of Medicine.
CKM syndrome describes the interconnected relationship among obesity, diabetes, chronic kidney disease, and cardiovascular disease. The syndrome is categorized into stages from 0 (no risk factors) to 4 (existing cardiovascular disease). The Life's Essential 8 framework includes healthy eating, physical activity, avoiding tobacco, healthy sleep, healthy weight, healthy cholesterol, healthy blood sugar, and healthy blood pressure.
Because the PREVENT equations, which estimate cardiovascular risk, are only validated for people aged 30-79, they were not applicable to this young cohort. Lloyd-Jones recommends that for people in their 20s, “the conversation focuses on Life’s Essential 8 and optimizing as many of those metrics as possible for better health today and long term.”
The study used ultrasound imaging of the carotid arteries to assess early signs of arterial injury, finding that more advanced CKM syndrome stages were associated with thicker carotid artery walls, an early marker of atherosclerosis. These findings suggest that opportunities to improve cardiovascular health and prevent disease progression exist long before cardiovascular disease becomes clinically apparent.
The study has limitations, including its cross-sectional design, which cannot establish cause and effect, and the use of some self-reported data. Additionally, the study population included many individuals from disadvantaged backgrounds, so the findings may not be generalizable to all young adults. Further long-term studies are needed to determine how CKM syndrome stage in young adulthood relates to future cardiovascular disease risk.
Lloyd-Jones emphasized that everyday health measures help people understand how lifestyle choices influence heart, kidney, and metabolic health over time. “For people in their 20s, we want to focus on improving cardiovascular health,” he said. The study highlights the critical need for early prevention efforts and regular cardiovascular health monitoring starting in young adulthood.
