DALLAS, Aug. 20, 2026 — A study of young adults in the United States has found that nearly eight in 10 participants already had some degree of cardiovascular-kidney-metabolic (CKM) syndrome, a condition linking excess body fat, metabolic abnormalities, chronic kidney disease and cardiovascular damage. The participants had an average age of just 23, yet those assigned to more advanced CKM stages showed measurable signs of early arterial injury. The findings, published in Circulation: Cardiovascular Quality and Outcomes, suggest that the biological processes leading to atherosclerosis may begin decades before a heart attack, stroke or other cardiovascular event becomes clinically visible.
Researchers analyzed health data from 1,283 participants enrolled in the Future of Families–Cardiovascular Health Among Young Adults, or FF-CHAYA, study. The cohort was intentionally diverse and included many individuals from socially and economically disadvantaged backgrounds. Investigators evaluated each participant using two complementary frameworks: the American Heart Association’s CKM syndrome staging system and its Life’s Essential 8 cardiovascular health score. They also used ultrasound imaging to examine the carotid arteries, the major blood vessels in the neck that supply blood to the brain. Changes in these arteries can provide an early window into vascular injury long before symptoms develop.
CKM syndrome is staged from 0 to 4 according to a person’s accumulation of risk factors and disease. Stage 0 indicates no identifiable CKM risk factors, while stages 1 through 3 reflect progressively greater abnormalities involving adiposity, glucose regulation, blood pressure, blood lipids, kidney function or subclinical cardiovascular disease. Stage 4 represents established cardiovascular disease, such as coronary heart disease, heart failure or stroke. In this young cohort, about 21% of participants were classified as stage 0, while nearly 80% met the criteria for stages 1, 2 or 3. None had reached stage 4.
The researchers found a clear relationship between more advanced CKM staging and early structural changes in the carotid arteries. Participants in the higher stages tended to have thicker carotid artery walls, a measurement known as carotid intima-media thickness. This thickening is considered an early marker of atherosclerosis, the gradual process in which cholesterol-rich plaques and inflammatory tissue accumulate within artery walls. Although increased carotid wall thickness does not mean that a person has an obstructed artery or will necessarily develop cardiovascular disease, it indicates that vascular biology may already be shifting toward greater stiffness, inflammation and plaque formation.
The association was especially striking because the participants were in their early 20s, an age when cardiovascular disease is often viewed as a distant concern. Arterial injury is usually detected after years of exposure to high blood pressure, unhealthy cholesterol levels, elevated blood sugar, smoking, excess body weight or impaired kidney function. The study indicates that these factors can combine early in adulthood, potentially accelerating damage before traditional clinical risk calculators identify a meaningful short-term threat. The findings therefore challenge the assumption that a young age alone protects people from the earliest stages of cardiovascular decline.
Participants with more advanced CKM syndrome also had lower scores on Life’s Essential 8, the American Heart Association framework for assessing cardiovascular health. The tool measures eight behaviors and health factors: diet, physical activity, tobacco exposure, sleep, body weight, cholesterol, blood glucose and blood pressure. Rather than producing a diagnosis, the score provides a broad assessment of how closely a person’s current health aligns with habits and biological measures associated with lower cardiovascular risk. In the study, lower scores generally accompanied more advanced CKM stages, reinforcing the idea that daily behaviors and measurable metabolic changes are closely connected.
Donald Lloyd-Jones, a study author, said the two approaches should be viewed as complementary rather than competing systems. CKM staging identifies the combination and severity of metabolic, kidney and cardiovascular risk, while Life’s Essential 8 offers practical targets that can be monitored and improved. Together, they may help clinicians recognize young adults who are beginning to accumulate risk even when they have no symptoms. For people in their 20s, the emphasis is not necessarily on predicting an imminent heart attack, but on identifying unfavorable trends and changing them before arterial injury becomes more advanced or irreversible.
Current American Heart Association and American College of Cardiology guidance recommends the PREVENT equations to estimate a person’s 10-year and 30-year risk of cardiovascular disease. However, those equations were developed and validated for adults between 30 and 79 years old, meaning they cannot be reliably applied to the participants in this study. In younger adults, the absence of a high calculated short-term risk may be misleading because age strongly influences the result. A 23-year-old can have obesity, elevated blood pressure, abnormal cholesterol or high blood sugar while still receiving a low near-term risk estimate. Monitoring Life’s Essential 8 measures may therefore provide a more useful starting point for prevention during this stage of life.
The researchers caution that the study cannot prove that CKM syndrome directly caused the arterial changes. Its cross-sectional design captured health status at one point in time, so it cannot establish whether the risk factors preceded the vascular injury or determine how the findings will affect future cardiovascular events. Several outcomes were also examined simultaneously, and some health behaviors were self-reported. Because the cohort included a substantial number of people from disadvantaged backgrounds, the results may not apply equally to every young adult population. Even so, the findings offer a powerful warning: cardiovascular prevention may need to begin well before middle age, when changes in weight, blood pressure, cholesterol, glucose, sleep, physical activity and tobacco exposure can still alter the trajectory of heart, kidney and metabolic health.
Subject of Research: Cardiovascular-kidney-metabolic syndrome, cardiovascular health and early arterial injury in young adults
Article Title: Association between Cardiovascular-Kidney-Metabolic Health and Early Arterial Injury in Young Adults in the United States: The Future of Families – Cardiovascular Health Among Young Adults Study
News Publication Date: Aug. 20, 2026
Web References: American Heart Association CKM syndrome information: https://www.heart.org/en/health-topics/cardiovascular-kidney-metabolic-syndrome/what-is-ckm-health; Life’s Essential 8: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8; American Heart Association newsroom: https://newsroom.heart.org/news/study-found-artery-damage-in-adults-in-their-20s-highlighting-need-for-early-cardiovascular-risk-assessment
References: DOI: 10.1161/CIRCOUTCOMES.125.013042
Keywords: cardiovascular-kidney-metabolic syndrome, CKM syndrome, young adults, arterial injury, carotid artery, atherosclerosis, cardiovascular health, Life’s Essential 8, obesity, diabetes, kidney disease, blood pressure, cholesterol, prevention
