Cardiovascular-kidney-metabolic syndrome (literature review)

Abstract

In press

Background. In recent years, the importance of the concept of cardiovascular-kidney-metabolic health has been increasingly emphasized, reflecting the close pathogenetic and clinical relationship between cardiovascular disease, renal dysfunction, and metabolic health in general. Cardiovascular and renal diseases, type 2 diabetes mellitus are key causes of high disability and mortality worldwide, and therefore impose a heavy economic burden on the health systems of all countries. The search for additional opportunities to provide more complete cardio- and nephroprotection in patients with diabetes mellitus and chronic kidney disease is a pressing issue at present.

Aim. Demonstration of the scientific and pathophysiological rationale for expanding the concept of metabolic syndrome to cardiovascular-renal-metabolic syndrome, as proposed by the American Heart Association (AHA).

Materials and Methods. This study is an analytical review of clinical and epidemiological studies from electronic databases, including PubMed and Google Scholar, mostly in the last five years, as well as official guidelines from the American Heart Association. Extensive population-based studies, including NHANES (National Health and Nutrition Examination Survey) III, were analyzed, and the pathophysiology, clinical manifestations, and treatment approaches for cardiovascular-renal-metabolic syndrome were examined. This study was conducted on the authors' own initiative and without additional funding.

Research Ethics. This work is a review of published scientific evidence and clinical guidelines and does not involve the implementation of interventions involving patients or the use of personal data, so local ethical committee approval was not required.

Results. In October 2023, the AHA for the first time officially defined what is called cardiovascular-kidney-metabolic syndrome, which is defined as a systemic disease characterized by pathophysiological interactions between metabolic risk factors, chronic kidney disease, and the cardiovascular system, leading to multiple organ dysfunction and a high level of unfavorable cardiovascular outcomes.

Conclusions. This review describes approaches to the definition, principles of staging, strategies for prevention, as well as algorithms for the treatment of cardiovascular- kidney-metabolic syndrome, presents the key provisions for the management of cardiovascular-kidney-metabolic syndrome, proposed in the indicated clinical recommendations.

Keywords: therapy, cardiovascular diseases, chronic kidney disease, type 2 diabetes mellitus, obesity.