Most people associate cardiovascular risk with the heart itself, but many important contributors begin elsewhere in the body. Metabolic health and kidney function are tightly linked to cardiovascular disease: diabetes and chronic kidney disease significantly raise the chance of heart problems, yet many people are unaware of these connections.
A 2025 American Heart Association (AHA) survey found low awareness of this link. The AHA also reports that roughly 1 in 4 U.S. adults with diabetes are undiagnosed, and the CDC estimates about 9 in 10 adults with chronic kidney disease are undiagnosed—often because of insufficient screening. The AHA’s statistics highlight widespread overlapping risk factors that drive what clinicians call cardiovascular-kidney-metabolic (CKM) syndrome: a clustering of metabolic, kidney, and cardiovascular dysfunction that can lead to disability and death if untreated. Estimates suggest as many as 90% of Americans may have this cluster or be unaware they are at risk.
Shared risk factors that increase risk across these organs include:
– High blood pressure
– High cholesterol
– High blood sugar/insulin resistance
– Excess weight, especially abdominal obesity
– Reduced kidney function
Population findings behind CKM’s prevalence include: about half of adults have high blood pressure; one in three has high cholesterol; roughly one in seven has kidney disease; more than half have prediabetes or diabetes; and over half have a high waist circumference. These factors individually and collectively stress the cardiovascular system.
Cardiologist Jack Wolfson, MD, explains how the components interrelate and what to look for:
What metabolic syndrome does to the heart
Metabolic syndrome is a cluster of conditions—abdominal obesity, insulin resistance, elevated triglycerides, low HDL, and high blood pressure. Insulin resistance leads to chronically high insulin, driving inflammation, endothelial dysfunction, and vascular stiffness. High triglycerides and small, dense LDL particles increase atherosclerotic risk. Visceral fat releases inflammatory cytokines. Over time, this promotes plaque formation, reduced nitric oxide production, arterial stiffening, and left ventricular hypertrophy—essentially early cardiovascular disease in motion.
How diabetes harms vessels and heart muscle
Type 2 diabetes involves chronic hyperglycemia and insulin resistance. Excess glucose causes glycation of proteins and lipids, producing advanced glycation end products that stiffen vessels, damage the endothelium, and increase inflammation and oxidative stress. Diabetes shifts lipid profiles toward more atherogenic particles and can lead to diabetic cardiomyopathy—myocardial fibrosis, impaired relaxation, and eventual reduced contractility. In short, diabetes both increases plaque risk and directly injures heart muscle and vessels.
The heart–kidney connection
The heart and kidneys form an integrated system. When kidney function falls, sodium and fluid retention raise blood volume and blood pressure, increasing cardiac workload. Kidney disease activates the renin-angiotensin-aldosterone system, causing vasoconstriction and fibrosis in both organs. Uremic toxins, elevated phosphorus, and chronic inflammation further damage vessels. Conversely, reduced cardiac output lowers kidney perfusion and worsens renal function—a vicious cycle called cardiorenal syndrome. Kidney dysfunction can be both cause and consequence of heart failure.
Recognizing CKM syndrome
CKM refers to concurrent cardiovascular, kidney, and metabolic dysfunction. Warning signs may include elevated fasting glucose or insulin, abdominal weight gain, high triglycerides, high blood pressure, declining estimated glomerular filtration rate (eGFR), elevated urine albumin, chronic fatigue, exertional shortness of breath, lower-extremity swelling, sleep disturbances, and brain fog. Early disease is often silent, so laboratory testing can reveal abnormalities before symptoms appear.
Prevention and protection
Prevention focuses on correcting the underlying metabolic terrain and restoring insulin sensitivity:
– Diet: Emphasize nutrient-dense, minimally processed foods that stabilize blood sugar and reduce inflammation. Prioritize high-quality protein, healthy fats, wild seafood, and micronutrient-rich foods.
– Activity and fitness: Strength training and regular daily movement improve insulin sensitivity and cardiovascular fitness.
– Sleep and circadian health: Adequate sleep and daylight exposure support metabolic regulation.
– Reduce toxic burden: Limit ultra-processed foods, environmental chemicals, plastics, and chronic psychological stress.
– Nutritional supports: When appropriate and guided by a clinician, nutrients that support nitric oxide production and mitochondrial function—magnesium, omega-3 fatty acids, CoQ10, and targeted amino acids like arginine or citrulline—may help.
– Testing: Measure fasting insulin, advanced lipid markers (particle number), kidney function (eGFR), albuminuria, and inflammatory and oxidative stress markers to detect early dysfunction.
CKM syndrome often develops gradually, but intervening on metabolic dysfunction at its root can restore resilience in the heart, kidneys, and vascular system. Greater awareness and screening are essential so individuals and their health care teams can address risks early and reduce the chance of serious cardiovascular complications.
