Cardiovascular

Contemporary Burden, Drivers, and Risk-Factor Control Gaps Across Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2021 to 2023.

Hyun S, Sze C, et al. • Journal of the American Heart Association • 2026

PubMed 42924845 DOI 10.1161/JAHA.126.053440
TL;DR

CKM syndrome affects most US adults, with stage-specific drivers and persistent risk-factor control and treatment gaps.

Key Findings

Results

Most US adults have some stage of cardiovascular-kidney-metabolic (CKM) syndrome, and only about one in nine are at stage 0.

  • The analytic sample included 2958 adults aged ≥20 years from the NHANES 2021-2023 fasting subsample, representing 245.2 million US adults.
  • Stage 0: 26.4 million adults (10.8%); stage 1: 56.8 million (23.2%); stage 2: 125.9 million (51.3%); stage 3: 13.4 million (5.5%); stage 4: 22.7 million (9.3%).
  • CKM stage ≥1 was present in 89.2% of adults.
Results

Two-thirds of US adults have CKM stage 2 or higher, and about 15% have advanced CKM (stages 3-4).

  • Stage ≥2 was present in 66.1% of adults.
  • Advanced CKM (stages 3-4) was present in 14.7%.
  • Stage 2 was the most common single stage (125.9 million adults, 51.3%).
Results

Among adults with stage 1 CKM, adiposity was the dominant driver, and about half had prediabetes.

  • 85.1% of stage 1 adults had adiposity.
  • 49.2% of stage 1 adults had prediabetes.
  • Stage 1 included 56.8 million adults (23.2%).
Results

Hypertension, metabolic syndrome, and hypertriglyceridemia were common drivers of stage 2 CKM.

  • Hypertension was present in 72.0% of stage 2 adults.
  • Metabolic syndrome was present in 56.1%.
  • Hypertriglyceridemia was present in 41.9%.
Results

Nearly all adults with stage 3 CKM met the PREVENT 10-year cardiovascular disease risk criterion.

  • 95.8% of stage 3 adults met the Predicting Risk of Cardiovascular Disease Events (PREVENT) 10-year CVD risk criterion.
  • Stage 3 included 13.4 million adults (5.5%).
Results

Risk-factor control gaps were common across stages 2 through 4, including elevated blood pressure and LDL cholesterol above target.

  • Blood pressure ≥130/80 mm Hg was present in 50.3% to 66.9% of adults across stages 2-4.
  • LDL cholesterol above the target was present in 64.5% to 73.9%.
Results

Many adults eligible for lipid-lowering therapy were not using it across stages 2 through 4.

  • Lipid-lowering therapy nonuse among eligible adults ranged from 30.1% to 59.2% across stages.

What This Means

This study used national health survey data from 2021 to 2023, covering about 245 million US adults, to estimate how many people fall into each stage of cardiovascular-kidney-metabolic (CKM) syndrome. CKM syndrome describes the combined effects of excess body fat, metabolic problems such as high blood sugar, kidney disease, and heart disease. Only about 11% of adults had no CKM features (stage 0). About 89% had at least early-stage CKM, about two-thirds had stage 2 or higher, and about 15% (roughly 36 million people) had advanced disease (stages 3-4). The main drivers differed by stage. In stage 1, most people had excess body fat and about half had prediabetes. In stage 2, high blood pressure, metabolic syndrome, and high triglycerides were common. Nearly all people in stage 3 had a high predicted 10-year risk of cardiovascular disease. The study also found substantial gaps in risk-factor control among people in stages 2 through 4. Half or more had blood pressure at or above 130/80 mm Hg, and about two-thirds or more had LDL cholesterol above the target. Between 30% and 59% of those eligible for cholesterol-lowering medication were not using it. This research suggests that CKM syndrome is very common in the US and that there is considerable room to improve blood pressure and cholesterol management. These figures can serve as benchmarks for tracking progress.

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Citation

Hyun S, Sze C, Khan T, Iwaniec J, Khan S, Bizanti A. (2026). Contemporary Burden, Drivers, and Risk-Factor Control Gaps Across Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2021 to 2023.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.053440