Metabolic risk factors can complicate kidney, cardiovascular health, according to panel
Combinations of risk factors, kidney disease and cardiovascular disease can be difficult to treat
A growing number of people have combinations of metabolic risk factors, chronic kidney disease and cardiovascular disease — possibly leading to a complicated diagnosis and treatment.
Chiadi Ndumele, MD, PhD, MHS, FAHA, associate professor of medicine at Johns Hopkins Hospital in Baltimore, Maryland, said historic levels of metabolic risk factors such as obesity and diabetes are disproportionately prevalent in disenfranchised populations, leading to a high burden of cardiovascular kidney metabolic (CKM) syndrome.
Dr. Ndumele will address those concerns during Sunday’s session, A Confluence of Risk: Navigating the Intersection of Cardiovascular, Kidney and Metabolic Health.
Janani Rangaswami, MD, FACP, FCRS, FAHA, professor of medicine at George Washington University School of Medicine in Washington, D.C., and Sheryl L. Chow, PharmD, FCCP, FAHA, FHFSA, associate professor at Western University of Health Sciences in Pomona, California, will also lead the panel discussion.
“In addition to causing diabetes, obesity leads to the development of high blood pressure, abnormal lipids and systemic inflammation,” Dr. Ndumele said. “In turn, high blood pressure and diabetes are the most common causes of chronic kidney diseases. Metabolic risk factors and chronic kidney disease each increase cardiovascular disease risk, and a synergistic increase is seen when both are present. Additionally, cardiovascular disease, particularly heart failure, increases risk for worsening chronic kidney disease.”
The primary consequence of this interplay between metabolic risk factors, chronic kidney disease and the cardiovascular system is premature mortality, usually from heart disease and stroke. And the medical community needs to address it right away, Dr. Ndumele said.
“It is believed that the high burden of CKM syndrome in the population has caused a plateau, and possibly even an uptick, in previously declining cardiovascular mortality rates over several decades,” he said. “Therefore, addressing the interplay between metabolic risk factors, chronic kidney disease and cardiovascular disease reflected by CKM syndrome is a public health emergency.”
More therapies are now available at the physician’s disposal to deal with CKM syndrome, Dr. Ndumele said.
“First, a recognition that excess adiposity is at the root of most CKM syndrome is important,” he said. “We have increasingly effective strategies for addressing obesity, through support for lifestyle modification, obesity pharmacotherapies and bariatric surgery, which can help reduce the pipeline of individuals with CKM syndrome.”
He said there’s also an increasing number of therapies with beneficial metabolic and kidney effects that can lower cardiovascular risk.
“For individuals with Type 2 diabetes, agents like SGLT2 inhibitors and GLP-1RAs have both beneficial and metabolic effects and reduce the risk of heart disease,” Dr. Ndumele said. “SGLT2 inhibitors, in addition to renin-angiotensin system inhibitors and finerenone, have protective effects against adverse kidney events and adverse cardiovascular events. Health care providers need more guidance on how and when to utilize these agents, which the clinical algorithms on CKM health developed by AHA have started to provide.”
For people with CKM syndrome, Dr. Ndumele said an interdisciplinary approach to care is critical.
“Many individuals with multi-organ impairment see multiple providers, which can lead to fragmented care, differing — and even conflicting — recommendations from different subspecialists, and challenges with navigating the health system,” he said.
This care can be value-based with support for health care professionals from a CKM interdisciplinary team using a CKM coordinator to communicate guidance. Or it can be volume-based to make sure high-risk patients with existing severe disease or who are at high risk for major adverse events are being referred to specialists to help optimize care.
“These complementary approaches can help to optimize interdisciplinary care for individuals with multi-organ impairment,” Dr. Ndumele said.