Heart Disease Often Starts in Your Kidneys or Blood Sugar, Not Your Heart

Ask most people what causes heart disease and they will mention cholesterol, smoking, or a sedentary lifestyle. They are not wrong. But an updated picture from the American Heart Association's 2026 statistics report points to a less recognized set of culprits that often precede cardiovascular disease by years: undiagnosed diabetes, untreated kidney disease, and the metabolic dysfunction that underlies both.

According to the report, approximately 1 in 4 U.S. adults with diabetes are unaware they have the condition. Centers for Disease Control and Prevention data cited in the report indicate that as many as 9 in 10 adults with chronic kidney disease do not know they have it. A consumer survey conducted in fall 2025 found that most people do not realize their heart, kidney, and metabolic health are interconnected at all.

The Shared Biology of CKM Syndrome

The medical term for the interconnection is cardiovascular-kidney-metabolic syndrome, or CKM syndrome. It describes how heart disease, kidney disease, and metabolic conditions like diabetes and obesity reinforce each other through shared mechanisms: high blood pressure, elevated blood glucose, abnormal cholesterol levels, excess abdominal weight, and reduced kidney filtration function. Having one condition increases the likelihood of developing the others, because these shared risk factors damage blood vessels and organs through similar pathways.

The biggest health threats from CKM syndrome are heart attacks and strokes - the "cardiovascular" component of the acronym. But the pathway often begins years or decades earlier, in the silent progression of diabetes or kidney disease before symptoms appear.

"We are encouraging people to become aware of the connection between conditions so they and their health care team can think about their overall health beyond individual conditions," said Stacey E. Rosen, M.D., volunteer president of the American Heart Association. "Understanding the connection helps you better prevent complications through lifestyle changes and appropriate treatment."

The Kidney Screening Gap

The statistics report highlights a specific deficiency in kidney disease detection. Two-thirds of patients with high blood pressure or diabetes - both of which place the kidneys at elevated risk - are not tested for kidney disease because they do not receive a urine albumin-to-creatinine ratio (uACR) test, which detects kidney damage by measuring protein leakage into urine. High blood pressure and diabetes together account for most cases of chronic kidney disease in the United States. Catching kidney impairment early allows treatment that can slow or prevent progression to kidney failure.

The report recommends two kidney tests for people with diabetes or high blood pressure: the uACR urine test and the estimated glomerular filtration rate (eGFR) blood test. These measure different aspects of kidney function and together provide a fuller picture than either alone.

Scale of the Problem

The numbers in the 2026 statistics report put the scope in perspective. Approximately half of all U.S. adults have high blood pressure. About one in three has high total cholesterol. More than half have prediabetes or diabetes. Over half have a waist circumference that falls in the elevated-risk category. About one in seven has chronic kidney disease. These are not rare conditions - they describe the majority of the American adult population at various stages of cardiometabolic risk.

According to the Association, approximately 80 percent of heart attacks and strokes are preventable, but risk factors tend to develop slowly with few or no early symptoms. Early detection and treatment require active screening rather than waiting for a patient to become symptomatic.

What Screening Involves

The CKM screening framework recommended by the Association includes blood pressure measurement, a full cholesterol panel (total cholesterol, LDL, HDL, and triglycerides), blood glucose and glycated hemoglobin (HbA1c) to assess diabetes status, waist circumference, and both the uACR and eGFR kidney tests. None of these tests require unusual equipment or procedures; most are available in a primary care setting during a routine physical examination.

The challenge is not the tests themselves but ensuring they are ordered, particularly the kidney function tests in patients who see high blood pressure or diabetes managed in isolation without an integrated metabolic and renal workup.

Implementation Efforts

The Association has launched an initiative supported by pharmaceutical sponsors including Novo Nordisk, Boehringer Ingelheim, Novartis, Bayer, and DaVita to enroll 150 health care sites across 15 U.S. regions in learning and sharing best practices for interdisciplinary CKM care. The initiative aims to reach more than 250,000 patients.

The Association also notes that its funding is primarily non-corporate (more than 85 percent from individuals, foundations, and investment income), with policies in place to prevent corporate donations from influencing clinical guidance or policy positions.

Limitations

The consumer survey results cited in the report are not detailed enough to evaluate methodology or sample representativeness in this summary. Statistics about awareness gaps rely on survey self-reporting and population inference rather than direct clinical measurement. Translating awareness campaigns into actual screening behavior change requires implementation steps that are more complex than information dissemination alone.