Millions of women may be unaware of their risk for cardiovascular-kidney-metabolic disease

Millions of women may be unknowingly living with risk factors for heart, kidney and metabolic disease – interconnected conditions that together drive risk for cardiovascular disease, the leading cause of death among women, according to experts with the American Heart Association, a global force changing the future of health for all.

The interplay of heart, kidney and metabolic health is called cardiovascular-kidney-metabolic (CKM) health. CKM health factors include blood pressure, cholesterol, weight, blood glucose (sugar) and kidney function. These factors are connected, so if something goes wrong in one area, it affects the others and can lead to CKM syndrome, which is associated with a high risk of cardiovascular disease.

The American Heart Association's new CKM health initiative, supported by founding sponsors Novo Nordisk and Boehringer Ingelheim and champion sponsor DaVita, aims to increase awareness of the interconnectivity among heart, kidney and metabolic conditions and improve treatment for CKM syndrome.

Below are five things women should know about their CKM health.

1. Know your greatest health risk.

Nearly 45% of women ages 20 and older are living with some form of cardiovascular disease, and 1 in 3 women will die from it.

"Despite heart disease being the leading cause of death for women, most are not aware of their risk of heart disease," said Sadiya S. Khan, M.D., M.Sc., FAHA, American Heart Association volunteer and Magerstadt professor of cardiovascular epidemiology, and an associate professor of cardiology and preventive medicine at Northwestern School of Medicine in Chicago.

Women may develop heart disease differently from men and experience symptoms that are uncommon in men. Women are more likely to have blockage in smaller blood vessels around the heart, and while chest pain is the most common heart attack symptom, women are more likely than men to experience pain in the arms, jaw, and neck, too.

2. Take action early.

When risk factors happen in multiples, heart risk escalates. Women with either Type 2 diabetes or chronic kidney disease are predicted to reach elevated risk for cardiovascular disease 8-9 years earlier than those without either condition. Women with both conditions may reach high risk 26 years earlier. Addressing heart, kidney and metabolic health at every stage of life can improve women's quality of life and overall health.

3. Know your connected risk factors.

Many people who have high blood pressure or diabetes, which increases the risk for kidney disease, are unaware of their kidney health due to lack of screening. Kidney health is assessed by either a urine test for protein or a blood test for the kidneys' filtration rate. Too much protein in the urine or a low filtration rate can indicate kidney disease.

Since high blood pressure and early stages of kidney disease and diabetes often don't have symptoms, regular screening is necessary to be aware of your risk.

"Knowing your health numbers is critical to optimize your CKM health and prioritize prevention of heart, kidney and metabolic disease," said Khan, who is on the science advisory group for the CKM health initiative.

Appropriate levels of CKM health factors for women are:

• Blood pressure – below 120/80 mm Hg
• Cholesterol levels that are important for CKM health:
  • Triglycerides – below 135 mg/dL
  • HDL (High-density lipoprotein, a.k.a. "good" cholesterol) – above 50 mg/dL 
• Weight assessments include waist circumference and body mass index (BMI):
  • Waist circumference – less than 35 inches (31 inches for Asian women)
  • BMI – under 25 kg/m2 (under 23 kg/m2 for Asian women)
• Blood sugar level, an assessment of diabetes risk, is measured in two ways:
  • Fasting blood glucose (short-term blood sugar) – 70-99 mg/dL
  • A1C (long-term blood sugar control) – below 5.7%
• Kidney health assessments:
• UACR (urine test for protein) – under 30 mg/g
• eGFR (blood test for filtration rate) – 90 mL/min/1.73 m2 or higher

When one CKM health factor is at an abnormal level it can bring others to unhealthy levels, too. However, the efforts to improve levels in one area – whether through lifestyle changes or appropriate medication – can also bring the others back into balance.

4. Pregnancy and menopause affect women's CKM health.

"Each pregnancy is a window into later heart, kidney and metabolic health," said Janani Rangaswami, M.D., FAHA, professor of medicine at the George Washington University School of Medicine and Health Sciences.

Pregnancy complications such as preeclampsia, gestational diabetes and gestational hypertension are risk factors for future chronic kidney disease, diabetes and cardiovascular disease, said Rangaswami, who is also co-chair of the scientific advisory group for the Association's presidential advisory that defined CKM syndrome. "Anyone wanting to be pregnant should optimize their heart and metabolic health before pregnancy," she added.

Changes during menopause also influence long-term heart and metabolic health. This includes declining estrogen levels, increased body fat around the organs, increased cholesterol levels and stiffening or weakening of blood vessels. In addition, early menopause, before age 45, is linked to a higher risk for kidney disease, Type 2 diabetes and cardiovascular disease.

5. Social factors impact women in unique ways.

Screening for social factors is an important part of CKM health assessment. Negative financial, social and neighborhood influences are associated with low levels of physical activity and healthy eating and high levels of obesity, heart disease and diabetes.

Some factors affect women differently than men. Marriage is related to worse health for women, and a higher percentage of women than men delay medical care because of costs. Women also face unique barriers to accessing care.

"Women are historically underrepresented in clinical trials, may have lower access to health care, less likely to receive evidence-based medication, and their health concerns may often be overlooked or dismissed," Khan said. "Because women's heart attack symptoms may also include nausea and shortness of breath, some women are told that they are experiencing anxiety."

The messages to women are to know your risk and advocate for your health.

"It's important to include pregnancy history on health forms and seek appropriate treatment for menopause symptoms," said Rangaswami.

"Sometimes being your best advocate is your best bet. We want to encourage every woman to feel empowered to advocate for themselves and their health," said Khan. "This should include requesting thorough screenings at health care visits and talking to a health care professional about your heart, kidney and metabolic health factors."