Cardiovascular-Kidney-Metabolic Syndrome in Youth

Cardiovascular disease, chronic kidney disease, and metabolic disorders, particularly those related to abnormal adiposity and insulin resistance, are among the leading causes of morbidity and mortality worldwide despite significant improvements in detection and treatment over the past 30 years. Epidemiological and clinical trial data have increasingly shown that these conditions are causally interconnected and whose individual treatments provide additional indirect beneficial effects on morbidity and mortality risk reduction. The American Heart Association coined the cardiovascular-kidney-metabolic (CKM) syndrome to better conceptualize that cardiovascular disease is a multisystem disease with major contributions from kidney and metabolic health. This provides a useful framework to guide opportunities for prevention and care optimization. As CKM syndrome and its antecedents can begin from preconception through early childhood, this new syndrome is particularly valuable for conceptualizing health in youth because it incorporates the developmental origins of health and disease, life course, and social determinants of health frameworks. This review contextualizes recent advances in understanding CKM syndrome screening and management in pediatric populations and introduces an innovative approach to integrating important frameworks to shape future clinical care models integrated with research strategies using transdisciplinary teams within academic learning healthcare systems. We emphasize innovations such as autonomy-focused coaching in transitioning care from pediatric to adult periods of life and a conceptual roadmap for healthcare systems as they design, implement, and evaluate these models of care. We introduce an opportunity to better leverage the value added by patients, families, caregivers, communities, and other key healthcare system partners such as dietitians, pharmacists, social workers, counselors, and nurse coordinators. This transdisciplinary care model can transform current CKM health paradigms to ultimately equitably optimize CKM health and quality of life across the life course, through a shared longitudinal plan that empowers patients with agency and autonomy to define and achieve their goals.