EXPLAINER: 90% of Americans Have This Disease — And Most Have Never Heard of It

In October 2023, the American Heart Association officially admitted something that changes everything: heart disease, kidney disease, and diabetes are not separate conditions — they're one syndrome. CKM syndrome. And 90% of US adults already have it.

CHAPTERS:
00:00 — 90% of Americans have this condition
01:02 — Part 1: What CKM syndrome actually is
01:20 — AHA Presidential Advisory: the 2023 definition
01:48 — The 4-stage system (Stage 0 through 4)
02:38 — JAMA 2024: only 10.6% are Stage 0
03:15 — 49% are Stage 2 — greatest opportunity for reversal
03:38 — Part 2: Why the AHA created it now
04:06 — Stage 3: 3x all-cause mortality, 7x cardiovascular mortality
04:40 — 45.3% of all cardiovascular deaths are CKM-attributable
05:26 — The disease starts silently in your 20s
06:10 — Part 3: The root cause finally acknowledged
06:22 — Stage 1 = dysfunctional adiposity, not high cholesterol
07:41 — HOMA-IR meta-analysis: 64% higher CAD risk, 76% stroke risk
08:09 — Part 4: The vindication
09:20 — The blind spot: AHA stages disease but won't say how to reverse it
09:47 — Part 5: What you can actually do
10:42 — Reduce processed food, TRE, walking, sleep

REFERENCES:

AHA Presidential Advisory on CKM (Circulation, 2023): AHA.org

CKM Prevalence in US Adults (Khan et al., JAMA, 2024): JAMA

CKM and Mortality NHANES Study (Am J Prev Cardiology, 2025): PMC12003006

AHA 2026 Statistics Update: pubmed/41562125

HOMA-IR and CVD Meta-Analysis 65 Studies (PLoS ONE, 2012): PMC3532497

HOST: Dr. Robert Lufkin MD | robertlufkinmd.com | Lies I Taught in Medical School

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Transcript

The 90% Health Blind Spot

SPEAKER_00 0:00

90% of American adults have a condition that most of them have never heard of. It's not a rare disease. It's not a new virus. It's a syndrome the American Heart Association quietly defined in 2023 and then, in their 2026 statistics report, gave it its own chapter for the first time ever. It's called CKM Syndrome, which stands for Cardiovascular Kidney Metabolic Syndrome. And according to a study published in JAMA, using national survey data, almost 90% of U.S. adults meet the criteria for stage one or higher. But when the American Heart Association surveyed the public, only 12% had ever even heard of it. Here's what makes this extraordinary. The AHA, the organization that spent decades treating heart disease, kidney disease, and diabetes as separate problems managed by separate specialists, just officially admitted they are the same disease. Different organs, same underlying dysfunction. That is exactly what my book has been saying since 2024. And today I'm going to explain what CKM syndrome actually is, why the AHA created it, and what it means for your health. I'm Dr. Robert Lufkin, physician, medical school professor, and this may be the most important thing you watch this year. Part one, what CKM syndrome is. In October 2023, the American Heart Association published a presidential advisory in circulation, which is their highest impact policy document led by cardiologist Dr. Ciadi Numbeli. For the first time, the AHA formally defined CKM syndrome as a systemic disorder connecting heart disease, kidney disease, type 2 diabetes, and obesity into a single clinical entity. They didn't just name it, they staged it like cancer. So what does that mean? Stage zero means no risk factors at all. Stage one means excess or dysfunctional adiposity, which is a clinical way of saying that your fat tissue isn't functioning properly. Stage two means you've developed metabolic risk factors, think high blood pressure, elevated triglycerides, diabetes, metabolic syndrome, or moderate chronic kidney disease. Stage three means subclinical cardiovascular disease or very high risk kidney disease, meaning organ damage has begun, but you don't still have symptoms yet. And stage four means established cardiovascular disease, heart attack, stroke, heart failure, often with kidney failure. Here's the critical number. A study published in JAMA in May 2024 by Kahn and colleagues applied these staging criteria to a nationally representative sample of U.S. adults using NHANES data from 2011 to 2020. Only 10.6% of adults qualified as stage zero. About 26% were stage one, and nearly half, 49%, were stage two, and about 15% were in the advanced stages, three or four. That means roughly 9 out of 10 American adults are already somewhere on this disease spectrum. And the AHA's own 2026 statistics update confirmed it. The majority of U.S. adults are living with CKM stages one through four, with most people in stage two, representing, in their words, quote, the greatest opportunity for prevention and regression, unquote. Part two. Why the AHA created it now. So why, after decades of treating these as separate diseases, did the AHA suddenly decide they're one syndrome? Because the data finally made it impossible to pretend otherwise. A follow-up study published in the American Journal of Preventive Cardiology tracks CKM stages against mortality outcomes using nearly two decades of NHANES data linked to the National Death Index. Compared to people at stage zero, those with stage three had nearly three times the risk of dying from any cause and over seven times the risk of dying from cardiovascular disease. At stage four, the risk of cardiovascular death was over ten times higher. But here's the number that should alarm every physician in America. The population attributable fraction, in other words, the percentage of deaths that could theoretically be prevented by moving people out of the advanced CKM stages was 45.3% for cardiovascular mortality. Nearly half of all cardiovascular deaths in the United States are attributable to advanced CKM syndrome. The AHA also found out that over 80% of young and middle-aged adults already show early CKM risk. Only 18% of adults aged 20 to 44 had stage zero. The disease isn't starting in middle age, it's literally starting in your 20s and 30s. Think silently with no symptoms, building towards a crisis decades later. And yet, as the AHA's own October 25 survey found, about 9 in 10 U.S. adults have never even heard of CKM syndrome. They don't know they have it. Their doctors may not be screening for it. And the medical system is still organized around treating each organ separately. You know, a cardiologist for your heart, a nephologist for your kidneys, and an endocrinologist for your blood sugar. Even though the AHA just told us it's the same disease process happening in all three. Part three, the root cause they're finally acknowledging. Now, here's the part that matters most. If you read the AHA's presidential advisory carefully, and I did, the starting point of CKM syndrome is stage one: excess or dysfunctional adiposity. Not high cholesterol, not high blood pressure, dysfunctional fat tissue. So what does that mean? It means adipose tissue that has become insulin resistant. Think fat cells are inflamed. They're leaking fatty acids into the bloodstream, pumping out inflammatory cytokines like TNF alpha and interleukin 6, and no longer responding properly to insulin signal to store energy. This is the trigger. The AHA is telling us the disease starts in your fat tissue and everything cascades from there. Now, a comprehensive review published in the American Journal of Physiology in 2025 made this explicit. Metabolic disorders, particularly insulin resistance and dyslipidemia, drive both renal and cardiovascular disease progression in CKM syndrome. The pathway runs from dysfunctional adipose tissue to insulin resistance, to hyperglycemia and elevated free fatty acids to endothelial dysfunction in your blood vessels, to kidney damage and atherosclerosis. This is not three diseases with one label. It's one disease with three manifestations. Insulin resistance impairs your blood vessels' abilities to dilate, raising blood pressure. It floods your liver with fatty acids, creating fatty liver disease and dyslipidemia. It damages the filtration units in your kidneys, the poticytes leading to kidney disease, and it drives chronic low-grade inflammation that accelerates atherosclerosis. A 2012 meta-analysis of 65 studies involving half a million people without diabetes found that insulin resistance, which we measure with HOMA IR, was associated with a 64% higher risk of coronary artery disease, a 76% higher risk of stroke, and a 44% higher risk of cardiovascular disease overall. This is the root cause, and the AHA just built an entire syndrome framework around it. Part 4. The vindication. And then in 2026, the American Heart Association published its annual statistics update, the most widely cited document in cardiovascular medicine, and for the first time in its history, included a dedicated chapter on the syndrome that says heart disease, kidney disease, and diabetes are pathophysiologically interconnected through metabolic dysfunction. They staged it, they quantified it, they showed that 90% of adults have it, and they called for interdisciplinary care that breaks down the silos between the specialties. That is not a disagreement with what I've been saying. That is the American Heart Association arriving at the same conclusion, though through a different door. The question is no longer whether these diseases are connected. The AHA settled that. The question is what you do about it. And that's where conventional medicine still has a blind spot. Because the AHA's staging model tells you what stage you're in. It does not tell you how to reverse the insulin resistance that put you there. Part five. What you can do. Here's the good news buried in the AHA's own data. They explicitly stated that for most people, CKM syndrome is reversible with changes to eating patterns, physical activity, and appropriate treatment. The 2026 report identified stage two as the stage with the greatest opportunity for prevention and regression. That means that nearly half the adult population is at a stage where the disease can be stopped or even reversed. But you have to address the root cause, not just the downstream numbers. Lowering blood pressure with a pill doesn't fix the insulin resistance that raised it. Lowering cholesterol with a statin doesn't fix the fatty acid overload coming from dysfunctional adipose tissue. Managing blood sugar with metformin helps, but it doesn't reverse the metabolic environment that created the problem. So what does? Reducing the processed food that drives insulin resistance, time-restricted eating that gives your body periods of low insulin to mobilize visceral fat. Walking, which activates glutes4 and AMPK pathways, improving insulin resistance sensitivity without medication. Adequate sleep, which regulates cortisol, you know, the hormone which literally drives this visceral fat accumulation. These are not fringe ideas. These are the mechanisms the American Heart Association's own framework is built on. They literally define the disease. The metabolic approach tells you how to reverse it. 90% of Americans have CKM syndrome, and most have never heard of it. Now you have.