Nearly 80% of Young Adults Show Signs of CKM Syndrome, Study Finds

Donald M. Lloyd-Jones, MD, MS, cardiologist and director of the Framingham Center for Population and Prevention Science at Boston University's Chobanian & Avedisian School of Medicine, is the corresponding author of a new study linking cardiovascular-kidney-metabolic (CKM) health to early arterial damage in young adults, published in Circulation: Population Health and Outcomes.

Traditional cardiovascular risk factors — elevated cholesterol, blood pressure, diabetes, and smoking — have long been linked to arterial damage detectable by neck ultrasound in older adults, Lloyd-Jones explained, and even childhood levels of these risk factors, within the normal range, predict later arterial injury. Although heart attacks and strokes typically strike in a person's 40s, 50s, and 60s, he said, the underlying atherosclerotic process often begins accelerating in the 20s, making young adulthood a critical window for identifying who is on a faster track toward cardiovascular disease.

To investigate, Lloyd-Jones and colleagues drew on the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, examining detailed carotid ultrasound measures in roughly 1,400 participants and linking them to the American Heart Association's CKM staging construct, which classifies cardiovascular-kidney-metabolic health from stage 0 (no risk factors) to more advanced stages of disease.

The results were striking: nearly 80% of participants, with an average age of just 23, fell into CKM stage 1 or higher, meaning only about 1 in 5 young adults in the cohort had no cardiovascular risk factors at all. Roughly 40% carried excess or unhealthily distributed weight, and another 40% already showed early markers such as elevated blood pressure, type 2 diabetes, or signs of kidney dysfunction. Lloyd-Jones attributed much of this burden to the broader obesity epidemic, which he called the leading driver of the pattern, though he noted that a substantial share of participants had already progressed beyond obesity to develop related conditions like hypertension and unfavorable cholesterol profiles.

Lloyd-Jones said the findings should prompt clinicians across specialties — not just primary care — to treat the early 20s as a pivotal window for cardiovascular prevention. He acknowledged the tendency for young patients to feel "immortal," recalling his own sense of invulnerability at that age even as risk factors quietly accumulated. He encouraged physicians to help patients in their 20s establish a relationship with a healthcare practitioner, understand their baseline numbers — cholesterol, blood pressure, blood sugar — and make a plan. At this life stage, Lloyd-Jones said, most emerging risk factors can still be addressed through lifestyle changes such as improved diet and more consistent physical activity, before medication becomes necessary; he added that he is generally reluctant to prescribe medication to patients in their 20s unless clearly warranted.

Disclosures: Donald Lloyd-Jones serves as an unpaid fiduciary director of the American Heart Association.

Reference: Krishnan V, Ning H, Notterman DA, et al. Association Between Cardiovascular-Kidney-Metabolic Health and Early Arterial Injury in Young Adults in the United States: The Future of Families-Cardiovascular Health Among Young Adults Study. Circ Popul Health Outcomes. 2026 Aug 20:e013042. doi:10.1161/CIRCOUTCOMES.125.013042