In recent years, researchers and clinicians have increasingly recognized the intricate, interconnected nature of cardiovascular, kidney, and metabolic health, especially as these domains collectively contribute to the burden of chronic diseases in women worldwide. The American Heart Association has taken a pioneering step in this direction by launching a comprehensive initiative aimed at shedding light on what is now termed cardiovascular-kidney-metabolic (CKM) health. This integrative viewpoint acknowledges that disorders in any one of these systems rarely exist in isolation; instead, they form a complex pathophysiological web that exacerbates risks for cardiovascular disease, which remains the leading cause of death among women globally.
Central to this new paradigm is the understanding that traditional risk factors—such as blood pressure, cholesterol levels, body weight, glucose regulation, and kidney function—must be assessed and managed collectively rather than in silos. The bidirectional relationships among these elements underscore the necessity for early detection and intervention strategies tailored specifically for women, who often experience disease progression and symptomatology in distinct ways from men. For example, women tend to develop obstructions in smaller coronary vessels rather than the large arteries typically implicated in male heart disease, and their symptoms during cardiac events can be atypical, manifesting as jaw, neck, or arm pain alongside or instead of chest discomfort.
The clinical implications of this are profound. Women frequently remain unaware of their elevated risk, which contributes to delayed diagnosis and suboptimal treatment. This knowledge gap is compounded by the observation that women with Type 2 diabetes or chronic kidney disease are predicted to reach critical levels of cardiovascular risk significantly earlier—by 8 to 9 years—compared to those without these conditions. When both diabetes and kidney disease are present, this risk escalates dramatically, in some cases accelerating cardiovascular disease onset by more than two decades. These sobering statistics highlight the urgent need for integrated screening protocols and personalized therapeutic interventions designed to modulate CKM health factors across a woman’s lifespan.
From a mechanistic perspective, abnormalities in any one CKM parameter can precipitate or intensify dysregulation in the others. Elevated blood pressure not only damages vascular structures but also impairs renal filtration and alters metabolic homeostasis. Similarly, dyslipidemia — characterized by elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol — fosters endothelial dysfunction and systemic inflammation, compounding cardiovascular strain. Accurate assessment of these parameters, alongside vigilant monitoring of body metrics like waist circumference and body mass index, provide clinicians with indispensable tools to stratify patient risk and devise multifaceted treatment plans.
Screening for kidney health remains a critical, yet often overlooked, component of this triad. Measurement of urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) enables early detection of renal impairment before symptomatic disease develops. This is particularly salient given that subtle kidney dysfunction and high blood pressure may not manifest clinical symptoms in their initial stages. Without routine laboratory assessments, many individuals remain unaware of insidious damage progressing silently, thereby missing vital windows for intervention.
Endocrinological transitions unique to women further complicate CKM health maintenance. Pregnancy acts as a physiological stress test, unmasking latent vulnerabilities in cardiovascular and metabolic systems. Gestational hypertensive disorders, preeclampsia, and gestational diabetes collectively increase susceptibility to future chronic kidney disease, hypertension, and Type 2 diabetes, outcomes that substantially elevate long-term cardiovascular risk. Equally pivotal is the menopausal period, during which the decline in estrogen disrupts vascular elasticity, enhances adiposity distribution toward visceral fat accumulation, and aggravates lipid abnormalities. Moreover, early menopause—defined as onset before 45 years of age—correlates strongly with heightened incidence of CKM-related diseases, emphasizing the importance of hormone-related factors in female-specific disease trajectories.
Beyond biological determinants, social and environmental factors exert significant influence on CKM health outcomes in women. Socioeconomic disadvantages, restricted access to healthcare, and psychosocial stressors collectively hinder preventive care and exacerbate disease burden. Notably, women face unique challenges including systemic underrepresentation in clinical trials, disparities in prescription of evidence-based therapies, and frequent dismissal of symptoms by healthcare providers. This dynamic is evident in instances where atypical cardiac symptoms in women—such as nausea and dyspnea without classic chest pain—are erroneously attributed to anxiety rather than evaluated for ischemic pathology.
Given these multifactorial contributors to CKM syndrome in women, the American Heart Association advocates for proactive health empowerment. It is critical that women become knowledgeable about their personal risk factors and actively engage with healthcare professionals to obtain comprehensive screenings encompassing cardiovascular, renal, and metabolic parameters. Inclusion of obstetric history in clinical evaluations is strongly recommended to identify individuals requiring intensified surveillance or early interventions. Furthermore, open dialogues regarding menopausal symptoms and strategies to address them can mitigate the deleterious cardiovascular and metabolic effects associated with hormonal changes.
Therapeutic approaches targeting CKM health necessitate a nuanced understanding of overlapping pathophysiologies. Lifestyle modifications—including dietary optimization, regular physical activity, weight management, and smoking cessation—remain foundational pillars in restoring and sustaining balance across the cardiovascular, kidney, and metabolic axes. Pharmacological regimens should be tailored with consideration of upstream and downstream effects among these organ systems, reflecting the interconnected nature of CKM syndrome. In this regard, emerging therapies that modulate multiple pathways simultaneously hold promise for more effective disease control.
The integration of nephrology, cardiology, and endocrinology offers fertile ground for innovative research and clinical care models designed to reverse the trends of premature cardiovascular morbidity and mortality among women. Enhanced awareness campaigns and targeted education provided by initiatives such as the American Heart Association’s CKM health program underscore the vital importance of multidisciplinary collaboration. Such efforts emphasize the critical window of opportunity available when health professionals and patients unite to prioritize CKM health before irreversible damage occurs.
In summary, the cardiovascular-kidney-metabolic health framework redefines conventional approaches to disease prevention and management by highlighting the intricate crosstalk among heart, kidney, and metabolic systems. This paradigm particularly benefits women, who are vulnerable to distinct genetic, hormonal, and social factors that converge to elevate risk. By adopting comprehensive screening protocols, fostering patient advocacy, and embracing holistic treatment strategies, significant strides can be made toward reducing the global burden of cardiovascular disease and improving women’s health outcomes across the lifespan.
Subject of Research: Cardiovascular-Kidney-Metabolic (CKM) Health in Women
Article Title: Understanding the Interconnected Risks of Cardiovascular, Kidney, and Metabolic Health in Women
News Publication Date: May 12, 2025
Web References:
- https://www.heart.org/en/professional/cardiovascular-kidney-metabolic-health
- https://newsroom.heart.org/news/heart-disease-risk-prevention-and-management-redefined
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001184
References:
- American Heart Association scientific advisory on CKM syndrome
- Relevant peer-reviewed articles on menopause transition and cardiovascular risk (Nov. 2020)
- Recent studies on accelerated cardiovascular risk in CKM syndrome (Nov. 2024)
Keywords: Cardiovascular disease, CKM health, women’s health, chronic kidney disease, metabolic syndrome, Type 2 diabetes, hypertension, menopause, pregnancy complications, heart disease risk factors, screening, therapeutic interventions
