Cardiovascular-kidney-metabolic: Hype or a focus on front-line health?

Cardiovascular-kidney-metabolic (CKM) syndrome, recently defined by the American Heart Association (AHA) in a 2023 presidential advisory, [1] represents a global public health crisis with prevalence exceeding 30% in adults aged over 40.The AHA staging system (Stages 0-4) categorizes disease progression from adipose dysfunction to organ damage.However, it omits hepatic biomarkers, even though liver fat accumulation precedes insulin resistance by 5-7 years.Second, overemphasis on cardio-renal outcomes ignores panmetabolic vasculopathy-systemic vascular injury affecting cerebral/peripheral beds through shared mechanisms (e.g., fetuin-A mediated endothelial dysfunction).Third, unaddressed clinical gaps in early-diagnosis criteria, pharmacokinetic interactions between sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RAs), and resource-appropriate screening.These limitations necessitate a liverincorporated paradigm that preserves CKM's clinical utility while enabling earlier intervention.