By Betsy McKay
Mitzi Franklin was diagnosed with high blood pressure at the age of 16. She didn't take it all that seriously, often skipping her medicine. "I was your typical teenager thinking I was invincible," she said.
A decade or so later, Franklin learned she had chronic kidney disease. At 42, she had a heart attack and a stroke, then four open heart surgeries. Then diabetes and congestive heart failure.
Franklin, now 54, is one of millions of Americans with cardiovascular-kidney-metabolic syndrome, a disorder defined in 2023 by the American Heart Association. It describes a cluster of conditions -- heart disease, diabetes, kidney disease -- that have common risk factors and fuel one another. Long treated as isolated or individual diseases, the conditions are interrelated, usually tied to excess abdominal fat, and a major driver of heart disease, according to the AHA.
On Tuesday, the AHA and three other medical societies published the first guidelines to help clinicians prevent and manage CKM, as it is called, urging them to focus on their patients' overall metabolic health. The goal is to prevent or slow the progression of conditions that may ultimately lead to heart attacks and strokes, which are becoming more common in younger adults.
The new guidelines call for doctors -- from primary care to cardiology -- to screen patients for metabolic risk factors and kidney function routinely. Risk from excess fat should be measured both by body-mass index $(BMI)$ and waist circumference, according to the new guidelines, which were developed by the AHA and the American College of Cardiology with the American Diabetes Association and American Society of Nephrology.
In the 1970s, smoking, high blood pressure and cholesterol were the classic risk factors for heart disease, said Dr. Chiadi Ndumele, chair of the committee that wrote the new guideline and a preventive cardiologist at Johns Hopkins University School of Medicine. Today, excess abdominal fat is a major risk factor because it can trigger chronic inflammation that damages arteries, cardiac tissue and kidneys, he said.
Nearly 90% of Americans meet the criteria for CKM, according to a 2024 study. Most people are in the first two of four stages, with excess body fat and some risk factors such as high blood pressure or cholesterol. Only 9.2% are at the most advanced stage, with heart failure or another diagnosed form of heart disease, along with other metabolic conditions such as kidney disease, according to the study.
There are drugs on the market that studies show have benefits for more than one of these conditions at once, such as GLP-1s and another class of drugs known as SGLT inhibitors.
While these diseases and even some treatments are interrelated, they are often treated as separate conditions with their own specialists -- cardiologists, endocrinologists and nephrologists, which can lead to delayed diagnoses or treatments.
Most people with high blood pressure, diabetes and obesity aren't screened for kidney disease, for example, said Dr. Daniel Weiner, a nephrologist at Tufts Medical Center, who was on a review committee for the new guideline. "If you delay treatment for too long, you lose an opportunity to prevent something that could be more serious down the road," he said.
Understanding the connection helps both the clinician and the patient, said Dr. Jay Shubrook, a family physician and professor at Touro University California, who wasn't involved with the new guideline. "I can say I'm worried that your current conditions are not affecting just your diabetes, but they're also affecting your heart and your kidneys."
Franklin learned she had kidney disease in her 20s when a new primary-care doctor saw that her blood pressure was chronically high and sent her to a nephrologist. By then, her kidneys had suffered damage.
A busy single mom, she focused on her heart in the years between her surgeries, exercising and trying to eat right, but didn't always keep up with her nephrologist. "Because I didn't really understand the connection, I focused on my heart, and then I kind of let my kidneys go by the wayside," said Franklin. She was also diagnosed with diabetes about five years ago.
Franklin, who lives in Rogers, Texas, and works as an information processor, learned a few years ago that her diseases were connected after doing some research and attending a conference. Now, she said, when she doesn't feel well, she doesn't automatically assume the problem is her heart. She also checks her blood sugar, for her diabetes, and to see how much water she is drinking, for her kidneys. "I feel the best I have felt now, because I understand they're connected," she said.
Write to Betsy McKay at betsy.mckay@wsj.com
(END) Dow Jones Newswires
June 09, 2026 14:00 ET (18:00 GMT)
Copyright (c) 2026 Dow Jones & Company, Inc.
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