Tanya Lewis: Hello. This is Scientific American’s podcast series, “Your Health, Quickly.”
Josh Fishman: We bring you the latest important health news that affects your body and mind.
Lewis: We then provide an in-depth analysis of medical research that can help you stay healthy. I’m Tanya Lewis.
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Fishman: I’m Josh Fishman.
Lewis: We are Scientific American’s senior health editors.
Today we’re going to talk about CKM syndrome, a newly recognized type of heart disease. CKM syndrome refers to a combination of cardiovascular disease, kidney disease, and metabolic diseases such as type 2 diabetes and obesity.
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Fishman: Our hospital has a highly specialized medical system. Sometimes it seems that each doctor has his own organ.
Lewis: right. If you have heart problems, see a cardiologist.
Fishman: And if your kidneys aren’t feeling well, you’ll probably consult a nephrologist.
Lewis: Alternatively, if you have diabetes or other hormone-related issues, you might see an endocrinologist.
Fishman: However, it turns out that these organs, and therefore health problems, are deeply connected to each other. Kidney problems and metabolic problems in particular increase the risk of cardiovascular disease, which can mean everything from heart attacks to clogged arteries.
Lewis: Therefore, this medical specialization may prevent physicians from seeing the complete picture of risk.
Fishman: that’s right. And that worries cardiologists like Sadiya Khan of Northwestern University.
Clan chief: People who write diabetes guidelines write about it, people who write kidney guidelines write about it, people who write heart guidelines write about it. But in reality, one patient does not follow her three different guidelines, and the clinician does not follow her three different guidelines.
Fishman: That’s why Kahn worked with kidney and endocrine experts to help write the American Heart Association’s new guidelines. The guidelines, released just a few months ago, define a new form of heart disease called cardiovascular-renal-metabolic syndrome.
Lewis: That’s a mouthful. There must be a shorter way to say it.
Fishman: There is. This is science, and they love that abbreviation, after all. Therefore, this is called CKM syndrome.
Lewis: It’s much easier. How common is CKM?
Fishman: According to the Heart Association, one-third of U.S. adults have at least three risk factors for the syndrome. Risk factors are numerous and include obesity, high blood pressure, and high blood sugar. And the kidneys determine how quickly pollutants are removed from the blood.
Khan: When present, or in combination, they synergistically increase the risk of developing heart disease or dying prematurely from heart disease.
Lewis: But how can problems in one organ cause problems in another?
Fishman: I also wondered the same thing. So I asked Kahn, who specializes in preventing heart and vascular diseases. She spends a lot of time observing the interactions between different organs.
Clan chief: It is often said that the kidneys and heart are like an old couple. It has long been known that kidney disease increases the risk of developing heart disease. So this connection exists. And the opposite is also true. Having heart disease increases your risk of developing kidney disease.
Lewis: I love the old couple analogy. But what is the biology behind this common risk?
Clan chief: Well, there are a lot of different mechanisms and crosstalk between two different organs.
Fishman: Basically, it starts with obesity. Excess fat cells secrete chemicals that cause inflammation. And it can damage blood vessels and damage tissue in both the heart and kidneys. Inflammation also makes cells less sensitive to insulin, the hormone that moves sugar from the blood into cells. Of course, increased blood sugar levels and decreased intracellular blood sugar levels are characteristic of diabetes.
Lewis: So, to use the old marriage analogy, if one spouse is upset about something, does that mean the partner will also be upset? And will the entire marriage fail?
fishman: Or you can go to counseling and work it out. In this case, I believe the counselor is a cardiologist.
Lewis: Without wanting to elaborate too much on the analogy, Dr. Khan said the cardiologist had known the couple for a long time. So why are they turning to treatment now?
fishman: I asked Khan the question “why now” and she said, “Why now?”
Khan: Yeah. I think one of the key drivers was the recognition that there is an increasing burden of these risk factors and conditions, and that they are often clustered together. Therefore, we know that rates of obesity, diabetes, kidney disease, and heart disease have increased over the past few decades.
Fishman: Therefore, everyone is at risk of CKM today. But Khan also mentioned something else.
Clan chief: This recognition is complemented by the availability of treatments that not only treat diabetes but also have heart and kidney protective effects. Therefore, the availability of treatments that allow for more comprehensive patient management was an important part of the problem.
Lewis: Is she saying there are new drugs that can target these overlapping diseases?
Fishman: That’s exactly what she’s talking about.
Clan chief: Treatments that have actually emerged in recent years include certain types of drugs that have cardiovascular effects, such as SGLT2 inhibitors and GLP1 receptor agonists, but they are also effective in treating people with kidney disease, diabetes, obesity, and others. It has also been shown to be effective for overweight and overweight people. .
Lewis: You’ve probably heard of GLP1 drugs, such as Ozempic and Wegovy, which are used to treat diabetes and weight loss, and may also protect against heart and kidney disease. SGLT2 inhibitors also act on the kidneys to help filter excess glucose from the blood, so they were originally developed as diabetes drugs. But since then, several large clinical trials have shown that it also reduces the incidence of heart disease.
Khan: They were developed as diabetes drugs, but it turns out they aren’t actually diabetes drugs at all. You can also call it heart medicine or kidney medicine. And I think this is also where this concept is so helpful, because we’re not just actually treating someone’s diabetes. We are trying to treat the patient in front of us.
Fishman: Well, Mr. Khan says that these drugs should not be used alone, but if a person has some risk factors, they should be used in conjunction with lifestyle changes (diet, exercise, the usual ones). I pointed out. In response to these advances, the Heart Association has also released a new risk calculator for physicians to use. It incorporates indicators for kidney disease and diabetes, along with heart risks. It’s a complex formula, but it ultimately allows doctors to know exactly how likely a person is to develop her CKM, or a more specific heart condition such as heart failure. Become.
Lewis: One key difference is that this tool allows doctors to start assessing risk starting at age 30. Previous assessment tools were only applicable to those over the age of 40.
Fishman: Yeah. Khan points out that if someone gets heart disease, the first signs appear between his 30s and 40s. And in its early stages, symptoms can be reversed with appropriate treatment.
Lewis: This is good news for me in my 30s! Recognizing CKM could mean more people are diagnosed and treated sooner, allowing them to live the majority of their lives in good health.
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Fischman: Your Health, Quickly is produced by Tulika Bose, Jeff DelViscio, Kelso Harper, Carin Leong, and us. Edited by Elah Feder and Alexa Lim. Our music was composed by Dominic Smith.
Lewis: Our show is part of Scientific American’s “Science, Quickly” podcast. Subscribe wherever you get your podcasts. If you like the show, please rate or review it. If you have a topic you’d like us to cover, please email us at: Yourhealthquickly@sciam.com. Get to know your health instantly at SCIAM.com.
For your health, I’m Tanya Lewis.
Fishman: And I’m Josh Fishman.
Lewis: See you next time.
