Key result
Stage 3 CKM linked to a ~0.10 mm increase in carotid intima-medial thickness in young adults.
Why the study?
It is unclear how the AHA Cardiovascular-Kidney-Metabolic staging construct applies to young adults and correlates with cardiovascular health status and carotid artery health.
Cross-Sectional (n=1,283)
Yes
In young adults, more advanced Cardiovascular-Kidney-Metabolic (CKM) stages are associated with worse cardiovascular health scores and greater evidence of early arterial injury, highlighting the need for early preventive efforts.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“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 health today and long term. For people in their 20s, we want to focus on improving cardiovascular health.”
May aid early identification of at-risk young adults; extends CKM staging to subclinical carotid injury but leaves prospective validation open.
BACKGROUND: The American Heart Association recently introduced the novel construct of Cardiovascular-Kidney-Metabolic (CKM) Syndrome, but it is unclear how the CKM staging construct applies to young adults and how it may correlate with cardiovascular health status and carotid artery health. METHODS: In the FF-CHAYA study (Future of Families-Cardiovascular Health Among Young Adults), we defined CKM stages using the American Heart Association's framework. Cardiovascular health was measured by Life's Essential 8 scores (a composite metric consisting of dietary quality, physical activity, sleep, nicotine exposure, body mass index, blood glycemia, blood lipids, and blood pressure). We examined cross-sectional associations of CKM stages with Life's Essential 8 scores and carotid ultrasonography measures using multivariable regression models adjusted for age, self-identified gender, and self-identified race/ethnicity. RESULTS: Among 1283 FF-CHAYA participants (mean [SD] age, 22.9 [0.7] years; 54.4% women), 20.7% of participants were classified as Stage 0 CKM (no risk factors), 40.2% as Stage 1 CKM (excess adiposity), 36.2% as Stage 2 CKM (metabolic risk factors), and 2.8% as Stage 3 CKM (subclinical cardiovascular disease or advanced kidney disease). Compared with Stage 0, participants in Stages 1 to 3 had significantly lower Life's Essential 8 scores (β, -7.6 [95% CI, -9.4 to -5.8] for Stage 1, -13.9 [95% CI, -15.7 to -12.0] for Stage 2, -13.2 [95% CI, -17.4 to -9.0] for Stage 3). In addition, Stages 1 to 3 had significantly higher mean-mean and mean-maximum carotid intima-medial thickness and lower gray scale median compared with Stage 0. For example, mean-maximum carotid intima-medial thickness was 0.014 mm higher (95% CI, 0.005-0.020) for Stage 1, 0.020 mm higher (95% CI, 0.017-0.035) for Stage 2, and 0.100 mm higher (95% CI, 0.085-0.128) for Stage 3, compared with Stage 0. CONCLUSIONS: Among young adults, a more advanced CKM stage was associated with worse cardiovascular health, including greater evidence of early arterial injury. These findings elucidate the need for earlier preventive efforts and population-level interventions to address upstream drivers of CKM health.
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Krishnan et al. (2026) conducted a cross-sectional in Young adults (primary prevention) (n=1,283). Advanced Cardiovascular-Kidney-Metabolic (CKM) stage (Stages 1-3) vs. Stage 0 CKM (no risk factors) was evaluated on Mean-maximum carotid intima-medial thickness (Stage 3 vs Stage 0) (MD 0.100, 95% CI 0.085-0.128, p=<0.01). Compared with Stage 0, young adults in Stage 3 CKM had higher mean-maximum carotid intima-medial thickness and lower Life's Essential 8 scores.