90% of adults in the U.S. at risk of heart disease. What to know about metabolic syndrome

In the United States, nearly 90% of adults over the age of 20 are at risk of developing heart disease, an alarming new study suggests.

While this surprisingly high number does not mean that the majority of adults in the United States have full-blown heart disease, it does indicate that many are at risk of developing the condition, even younger people.

Researchers identified people at high risk using a newly defined syndrome that takes into account the strong links between heart disease, obesity, diabetes and kidney disease, according to the study published Wednesday in JAMA.

The American Heart Association alerted doctors in October about cardiovascular-kidney-metabolic (CKM) syndrome, a disease that affects the body’s major organs, including the brain, heart, liver and kidneys. CKM is diagnosed in stages from zero (no risk factors for heart disease) to 4 (people with diagnosed heart disease with excess body fat, metabolic risk factors such as hypertension and diabetes or kidney disease).

For the new study, researchers analyzed nearly a decade of data from more than 10,000 people participating in the National Health and Nutrition Examination Survey (NHANES).

“We were absolutely surprised to find that almost 90% of people met the criteria,” said study co-author Dr. Rahul Aggarwal, a cardiology researcher at Brigham and Women’s Hospital at Harvard Medical School, in Boston. “This was much higher than we expected in a database including young adults.”

The finding that nearly 50% of NHANES participants were CKM stage 2, meaning they were at moderate risk because they had high blood sugar, hypertension, high cholesterol or chronic kidney disease , has been particularly worrying, Aggarwal said.

Just over a quarter of the group – people classified as stage 1 – were at increased risk of developing heart disease due to being obese or overweight, having excess abdominal fat and fat around their organs, but did not present specific symptoms.

The researchers found that 15% of participants had advanced disease, a number that remained fairly constant between 2011 and 2020.

“I think one of the biggest contributing factors to the percentage of people in advanced stages not getting better is obesity, which is very prevalent in the United States,” Aggarwal said, adding that 40% of Americans are obese. According to the Centers for Disease Control and Prevention, another 32 percent are overweight, based on body mass index calculations.

Carrying around extra pounds increases a person’s likelihood of having high blood pressure, high blood sugar, and high cholesterol, although some have metabolic risk factors even if they are at a healthy weight.

Participants aged over 65 were more likely to have advanced disease than those aged 45 to 64. But being young wasn’t as protective as one might assume. Only 18% of people aged 20 to 44 were in stage zero. In other words, they presented no risk factors.

The new findings show that health care providers need to detect these conditions earlier “before they lead to downstream effects,” such as increased risk of heart attack, heart failure and stroke. cerebral, Aggarwal said. “We need to diagnose earlier and be more aggressive in treating people. »

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Making lifestyle changes, such as eating better and being more active, can help protect you against heart attacks and strokes.

The results also show that “young adults, those under 45, are not as healthy as we thought,” Aggarwal said.

Experts were also surprised by the high rates of CKM.

“It is alarming that 90% of the population is at least stage 1 and only 10% have no risk factors,” said Dr. Sripal Bangalore, professor of medicine and director of invasive and interventional cardiology at NYU Langone Health in New York. .

He attributes these figures to the epidemic of overweight and obesity.

“We have a lot of work to do to reduce rates of overweight and obesity,” Bangalore said. “If we can do that, then we can hopefully reduce the number of people who progress to stage 2 and also move the needle down to the higher stages.”

Including kidney disease in cardiovascular disease risk assessments makes perfect sense, said Dr. Adriana Hung, a kidney specialist, epidemiologist and professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

“Kidney disease makes cardiovascular disease worse,” she said. “Some studies show that a patient is up to six times more likely to die from cardiovascular disease if kidney disease is also present.”

The new, broader approach to heart disease is likely to help identify more people at risk, said Dr. Robert Rosenson, director of lipids and metabolism at the Mount Sinai Health System in New York.

“The main message of this study should be that many common behaviors lead to an accumulation of diseases over the lifespan, which will impact quality of life and survival,” he said.

The large number of people with CKM in this study is linked to overweight and obesity, insulin resistance and a diet high in fat and salt, Rosenson added.

People need to understand that it’s not just the heart that is damaged by unhealthy diet and lack of exercise, he said, but that lifestyle factors also have an effect on cognition .

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