A Suite of Killers

Heart ailments, kidney diseases and type 2 diabetes actually may be part of just one condition. It's called CKM syndrome

- JYOTI MADHUSOODANAN

AMY BIES WAS RECOVERING in the hospital from injuries inflicted during a car accident in May 2007 when routine laboratory tests showed that her blood glucose and cholesterol were both dangerously high.

Doctors ultimately sent her home with prescriptions for two standard drugs, metformin for what turned out to be type 2 diabetes and a statin to control her cholesterol levels and the heart disease risk they posed.

The combo, however, didn't prevent a heart attack in 2013. And by 2019 she was on 12 different prescriptions to manage her continued high cholesterol and her diabetes and to reduce her heart risk. The resulting cocktail left her feeling so terrible that she considered going on medical leave from work. "I couldn't even get through my day. I was so nauseated," she said. "I would come out to my car in my lunch hour and pray that I could just not do this anymore."

Medical researchers now think Bies's conditions were not unfortunate co-occurrences. Rather they stem from the same biological mechanisms. The medical problem frequently begins in fat cells and ends in a dangerous cycle that damages seemingly unrelated organs and body systems: the heart and blood vessels, the kidneys, and insulin regulation and the pancreas. Harm to one organ creates ailments that assault the other two, prompting further illnesses that circle back to damage the original body part.

Diseases of these three organs and systems are "tremendously interrelated," says Chiadi Ndumele, a preventive cardiologist at Johns Hopkins University. The ties are so strong that in 2023 the American Heart Association grouped the conditions under one name: cardio-kidney-metabolic syndrome (CKM), with “metabolic syndrome” referring to diabetes and obesity.