• New research reports that people with chronic kidney disease have an elevated cardiovascular disease risk eight years earlier than people without the disease.
• Researchers add that people with type 2 diabetes have the elevated cardiovascular risk about a decade earlier.
• People with both conditions can have that higher risk as much as 28 years earlier than people without those diseases, researchers say.
• Experts say you can maintain good heart health by eating a healthy diet, exercising regularly, and managing stress levels.

People with type 2 diabetes have an elevated risk of developing cardiovascular disease earlier than someone who doesn’t have the condition. The same goes for those with chronic kidney disease.

For people with both conditions, however, the risk may be much higher, according to new research being presented November 16–18 at the American Heart Association’s Scientific Sessions 2024 in Chicago.

The study has not yet been peer-reviewed or published in a scientific journal, but the researchers said their report provides valuable information.

“Our findings help to interpret the combination of risk factors that will lead to a high predicted [cardiovascular disease] risk and at what age they have an impact on risk,” Vaishnavi Krishnan, lead study author and researcher at Northwestern University in Chicago, and medical student at Boston University School of Medicine, said in a statement.

“For example, if someone has borderline-elevated levels of blood pressure, glucose and/or impaired kidney function, but they don’t yet have hypertension or diabetes or chronic kidney disease, their risk may not be recognized. Understanding how age interacts with risk factor levels is important to optimize [cardiovascular-kidney-metabolic] health,” Krishnan continued.

How age may affect cardiovascular disease risk

In October 2023, the American Heart Association identified a new condition called cardiovascular-kidney-metabolic syndrome.

CKM syndrome makes the connections between cardiovascular disease, kidney disease, obesity, and diabetes. Its risk factors have four stages.

In May 2024, experts reported that 90% of adults in the United States may have CKM syndrome.

In the new research being presented this week, researchers report females with CKM syndrome can expect to reach an elevated risk for cardiovascular disease at age 68. For males with the condition, the age of increased cardiovascular disease risk is 63.

The researchers said that for females with type 2 diabetes, the predicted 10-year cardiovascular disease risk was elevated at age 59. For males, it was 52. That is 9 years earlier for females and 11 years earlier than males compared to those without the condition.

They also reported that for females with stage 3 chronic kidney disease, the predicted cardiovascular risk was elevated at age 60, while for males, it was 55. Both are 8 years earlier than people without the disease.

For people with both type 2 disease and kidney disease, the researchers said the 10-year risk for females was elevated at age 42 while for males it was 35. That’s 26 years earlier for females and 28 years earlier for males compared to people without CKM syndrome.

Experts say the findings are startling.

“Surprising to see such a significant impact on health and quality of life with disease developing nearly three decades sooner (28 years). That is really jaw dropping,” Jayne Morgan, MD, a cardiologist and vice president of medical affairs for Hello Heart, told Healthline.

“Even astute clinicians will likely be surprised by the sobering prediction that the co-existence of these two problems radically increases the risk of early myocardial infarction and stroke,” added Richard Wright, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.

New research is a ‘simulated’ study

It should be noted that this research was a simulated study as opposed to using information from medical records of patients.

For this study, the researchers used data from the National and Nutritional Examination Survey 2011-2020.

The researchers utilized this information to create risk profiles to simulate men and women for chronic kidney disease and/or type 2 diabetes at each age from 30 to 79 years.

They then used the American Heart Association Predicting Risk of cardiovascular disease EVENTS (PREVENT) calculator to try to determine at what age someone with each risk profile could be expected to have a higher risk of cardiovascular disease.

Experts said the simulated study does have its merits.

“This interesting and provocative analysis is only a simulation and is not based on actual clinical data, but nevertheless, dramatically points out the potential ‘more-than-additive’ risk these conditions possess in predicting future cardiovascular events,” Wright told Healthline.

“Although not as scientifically sound as an actual prospective population study, the current assessment is based on valid science and should not be ignored,” he added.

“To gauge risk, one can use multiple methods, including retrospective review, a prospective study, or what the authors did — a simulated risk in a simulated population (i.e. not actual patients),” Marilyn Tan, MD, the chief of the Stanford Endocrine Clinic in California, told Healthline.

“With a simulated risk, the goal is to use various models to identify how different medical factors impact risk,” she noted.

How diabetes and kidney disease affect heart health

Cardiovascular disease (CVD) is an umbrella term that includes heart disease, heart attack, and stroke that may cause serious health issues.

Atherosclerosis is a condition where plaque builds up in the walls of the arteries. This narrows the arteries, making it more difficult for blood to follow and potentially leading to a heart attack or stroke.

Heart failure is also a form of CVD, which occurs when the body isn’t pumping blood as well as it should.

Heart valve problems may also develop with CVD, as well as arrhythmia, which is when the heart beats irregularly. The most common form of arrhythmia is atrial fibrillation (AFib).

The American Heart Association reports that nearly half of all adults in the U.S. are living with some form of cardiovascular disease. Around 1 in 3 has at least three risk factors that contribute to cardiovascular-kidney-metabolic syndrome.

Experts say conditions such as kidney disease and diabetes have a direct effect on heart health.

“Type 2 diabetes leads to high blood sugar levels, which damage the blood vessels in our body. This then results in atherosclerosis which can then lead to conditions such as heart attack and stroke,” explained Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California.

“Similarly, chronic kidney disease can have effects such as increased blood pressure, atherosclerosis, and inflammation, all of which can then increase the risk of cardiovascular disease,” Chen told Healthline.

“Unhealthy kidneys cannot regulate blood pressure, leading to hypertension,” Morgan added. “Hypertension damages blood vessels and the heart. Sodium retention increases as the kidneys fail, further increasing blood pressure and the workload of the heart, which could lead to heart failure.”

“High blood glucose damages blood vessels and nerves both within the heart and supplying blood to the heart,” she noted. “This leads to early plaque buildup and atherosclerosis, further increasing the risk of heart attacks.”

How to improve your heart health

The American Heart Association has launched a four-year Cardiovascular-Kidney-Metabolic (CKM) Health Initiative.

The initiative will help assess gaps in clinical care as well as identify areas for future research. It will also implement guidelines and screening recommendations.

There are myriad steps you can take to improve your heart health, such as:

• Follow a heart-healthy diet low in sodium and saturated fats with high amounts of fruits and vegetables.
• Stay active and exercise regularly.
• Don’t smoke and avoid second-hand smoke.
• Manage your stress levels.

Experts had praise for the AHA’s new health initiative.

“This is a great initiative to really understand the interplay of these disease processes on the heart, the body, and on healthy aging,” Morgan said.

“It’s great that the AHA is working on guidelines and educating other healthcare providers (including nephrologists and endocrinologists) to promote best practices for reducing cardiovascular risk in the setting of kidney and metabolic disease,” added Tan.

“This is truly a call to action, to both identify those at such risk and to begin more aggressive treatment, earlier than we have traditionally felt necessary,” said Wright.

“Fortunately, it is known that aggressive lifestyle changes, weight loss, hypertension control, and use of modern pharmacologic therapies can interrupt the vicious CKM spiral and can bend the risk curve in the desired fashion. The American Heart Association should be commended for starting their CKM Initiative and placing a spotlight on this issue. We can only hope that the medical community pays attention,” Wright added.

Takeaway

Researchers say conditions associated with cardiovascular-kidney-metabolic syndrome can elevate a person’s risk of cardiovascular disease at an earlier age.

They report that people with chronic kidney disease can reach that elevated risk eight years earlier than people without the disease.

They add that people with type 2 diabetes can see an elevated risk a decade earlier than those without the condition.

They stress that people with both these diseases, known as cardiovascular-kidney-metabolic syndrome, can see an elevated cardiovascular disease risk as much as 28 years sooner than people without this condition.