Managing patients with cardiovascular-kidney-metabolic syndrome: a guideline-driven practical guide for primary care physicians

Le résumé fourni par la source

Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder characterized by an overall reduction in cardiovascular health that occurs as a result of the development of ≥2 cardiovascular, kidney, or metabolic risk factors. Prevalence of CKM syndrome and its contributing conditions is rising, carrying an associated increase in excess morbidity, premature mortality, and direct and indirect health-related expenditures for patients, particularly for individuals with adverse social determinants of health. The growing body of evidence supporting CKM syndrome as a single, multifactorial disease underscores the importance of implementing an overarching, interdisciplinary therapeutic approach for the prevention and management of each facet of the disease. The recent development of several therapies with multiple benefits for cardiovascular, kidney, and metabolic health provides an important opportunity to facilitate the development of treatment plans that address the root cause of CKM syndrome for patients in early stages and to alleviate symptoms, delay progression, and improve quality of life in later stages of the syndrome. These developments provide a challenge for primary care physicians (PCPs) to ensure they are managing patients at their current disease stage, with the most appropriate combination of therapies available. This review aims to provide PCPs with a guideline-driven, practical guide to facilitate these decisions on the most appropriate management path for different scenarios for patients with CKM syndrome. Obesity (extra body fat), cardiovascular disease (disorders of the heart and blood vessels), diabetes (high blood sugar), and chronic kidney disease (reduced kidney function) often coexist and can cause significant health problems. When two or more of these conditions occur together, it can lead to cardiovascular-kidney-metabolic (CKM) syndrome. CKM syndrome increases the chances of multiple organ damage, particularly affecting the heart and kidneys. CKM syndrome is also associated with high treatment costs and can impair a person’s ability to work or attend school. Social factors, such as limited access to safe housing and healthy food, further increase the risk of developing CKM syndrome. Managing CKM as a single condition may improve patient outcomes. This article provides primary care physicians (PCPs) with guidance on preventing, diagnosing, and managing CKM syndrome. The condition is categorized into four stages, ranging from early (stage 1) to serious disease (stage 4). PCPs play a key role in advising patients on lifestyle changes, including healthy eating, weight management, and physical activity. Pharmacologic treatment, particularly the use of combination therapies, is also central to management, and PCPs must understand how to tailor these treatments to individual patient needs. Given the complexity of CKM syndrome, PCPs often collaborate with different types of healthcare professionals to optimize care. To support clinical decision-making, the article also includes fictional but realistic patient case studies illustrating different disease stages, along with recommended treatment approaches.

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