CKM Syndrome, Artery Damage Prevalence Higher in Young Adults than Previously Believed

Almost 8 in 10 young adults in their early 20s have cardiovascular-kidney-metabolic (CKM) syndrome – and patients with more advanced CKM showed more signs of arterial damage, according to new data from the American Heart Association.1

CKM syndrome describes the relationship between obesity, diabetes, chronic kidney disease (CKD), and cardiovascular disease. Recently released clinical guidelines have developed a categorization system in which different stages reflect a person’s risk factors. These stages range from Stage 0 (no risk factors) to 4 (existing cardiovascular conditions like coronary heart disease, stroke, or heart failure).1

“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,” Donald Lloyd-Jones, MD, MS, a cardiologist at Boston Medical Center, professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine, director of the Framingham Center for Population and Prevention Science, and lead author of the study, said in a statement.1

The study, titled Future of Families-Cardiovascular Health Among Young Adults (FF-CHAYA), was an ancillary study of the Future of Families and Child Well-Being Study (FFCWS). The latter enrolled roughly 5000 mother-baby dyads at birth between 1998 and 2000, with an oversampling of unmarried mothers. FFCWS conducted 7 waves of data collection at birth and roughly ages 1, 3, 5, 9, 15, and 22 of the children. The FF-CHAYA substudy involved an in-person examination after completing year 22 of FFCWS.2

The in-person examination consisted of objective assessments of blood pressure and anthropometric measures, as well as phlebotomy for lab analyses of blood lipids, hemoglobin A1c, and serum creatinine, and carotid ultrasonography. Patients also completed self-administered questionnaires regarding medical history and medication usage, as well as standardized questionnaires to assess diet, physical activity, sleep, and nicotine exposure.2

Lloyd-Jones and colleagues used the staging construct from the American Heart Association to assign each participant to a CKM stage between 0 and 3. Stage 0 CKM represents no risk factors, stage 1 CKM represents excess or dysfunctional adiposity, Stage 2 represents metabolic or kidney risk factors, and Stage 3 represents subclinical cardiovascular disease or high-risk equivalents. Stage 4 CKM was not included in the analysis, as patients meeting criteria for clinical cardiovascular disease were excluded from the study.2

The 1283 patients who were included in the final sample had a mean age of 22.9 years (standard deviation [SD] 0.7), and 54.4% were women. Of these patients, Lloyd-Jones and colleagues classified 20.7% at Stage 0, 40.2% at Stage 1, 36.2% at Stage 2, and 2.8% at Stage 3, indicating a significant burden of excess adiposity, medical risk factors, and subclinical cardiovascular disease, respectively.2

Mean Life’s Essential 8 scores were also calculated for each patient – among the full FF-CHAYA patient group, mean cardiovascular health score was 69.2 (95% CI, 68.4-69.9). Overall scores differed by CKM stage, from 77.6 (95% CI, 76.1-79.1) in Stage 0 to 64.4 (95% CI, 60.5-68.4) in Stage 3 (P <.01). While mean health behaviors-only scores and individual health behavior metrics did not significantly differ across stages, mean dietary quality and physical activity scores were low.2

Carotid ultrasonography revealed that mean-mean common carotid intima-medial thickness (cIMT) was 0.504 mm (0.501-0.507), while mean-maximum cIMT was 0.641 mm (0.637-0.644) and gray scale median was 77.3 (76.5-78.1). More advanced CKM stage saw both mean-mean and mean-maximum cIMT increase substantially, while gray scale median was significantly lower.2

Lloyd-Jones and colleagues did note a few limitations to the study, including its cross-sectional design’s inability to establish cause and effect and the study population’s inclusion primarily of patients from disadvantaged backgrounds. This may reduce the generalizability of the data. However, the team concluded that these findings still represent an urgent need for prevention efforts earlier in life.1

“In my practice, and what I would recommend, is that the conversation focuses on Life’s Essential 8 and optimizing as many of those metrics as possible for better heart health today and long-term,” Lloyd-Jones said in a statement. “For people in their 20s, we want to focus on improving cardiovascular health.”1

References

1. American Heart Association. Study found artery damage in adults in their 20s, highlighting need for early cardiovascular risk assessment. Eurekalert! August 20, 2026. Accessed August 20, 2026. https://www.eurekalert.org/news-releases/1140275

2. Krishnan V, Ning H, Notterman DA, et al. Association between cardiovascular-kidney-metabolic health and early arterial injury in young adults in the United States: The future of families–cardiovascular health among young adults study. Circulation: Population Health and Outcomes. August 20, 2026. Accessed August 20, 2026. doi:10.1161/circoutcomes.125.013042