CKM Syndrome Prevalence and Its Association With SCORE-2 and BRI

Cardiovascular diseases, diabetes, and chronic kidney diseases are among the leading causes of morbidity and mortality both globally and in Türkiye \[1\]. The Cardiovascular-Kidney-Metabolic (CKM) Syndrome, which defines the shared pathophysiological basis of these conditions, was classified in 2023 by the American Heart Association (AHA) using a stage-based system ranging from 0 to 4 \[1,2\]. This study aims to present, for the first time from Türkiye, community-based prevalence data on CKM Syndrome within the framework of this new definition.

In a large-scale cross-sectional study conducted in the United States by Zhu et al. in 2024 \[3\], CKM stages were found to be associated with social determinants such as education, income, housing, and employment. However, to date, no field study has been conducted in Türkiye based on the AHA's CKM staging system.

This study will also examine the correlation between CKM stages and both the SCORE-2 risk score and the Body Roundness Index (BRI). SCORE-2, developed by the European Society of Cardiology, is a reliable model for estimating 10-year cardiovascular risk based on age, sex, smoking status, systolic blood pressure, total cholesterol, and HDL levels \[4,5\]. BRI is a novel anthropometric parameter that more sensitively reflects abdominal obesity than body mass index (BMI) \[6,7\].

With these objectives, the study will:

Provide the first community-based field data on CKM stages in Türkiye,

Reveal the relationships between CKM stages, SCORE-2, and BRI,

Generate locally relevant findings to inform primary care practices.

By demonstrating the usability of test data already obtained within the scope of the Disease Management Platform (HYP), the study will offer a cost-effective model.

In conclusion, this study will provide pioneering data for both the epidemiological assessment and practical management of CKM syndrome screening in Türkiye.

CKM Staging (Stage 0-4) is defined as follows \[2\]:

Stage 0 - Low Risk Individuals with no identifiable risk factors; considered healthy.

Stage 1 - Early Risk

Presence of at least one metabolic risk factor:

Overweight or obesity (particularly abdominal obesity)

Prediabetes (elevated fasting glucose or HbA1c)

Poor dietary habits and low physical activity

Elevated-normal blood pressure (prehypertension)

Low HDL and/or high triglycerides

Stage 2 - High Risk / Subclinical Disease Individuals with multiple metabolic risk factors but without clinically diagnosed cardiovascular or kidney disease.

Typical combinations in this stage may include:

Dyslipidemia + Prediabetes + Abdominal obesity

Stage 3 - Established Disease

Individuals with a diagnosis of one or more of the following:

Type 2 diabetes

Hypertension

Chronic kidney disease (eGFR \< 60 mL/min/1.73 m²) But who have not yet experienced a major cardiovascular event

Stage 4 - Cardiovascular Outcome

Individuals diagnosed with atherosclerotic cardiovascular disease (ASCVD), including:

Myocardial infarction

Stroke

Peripheral artery disease

Basic Data Required for CKM Staging:

Anthropometric Measurements:

Body Mass Index (BMI), waist circumference, neck circumference, waist-to-height ratio, Body Roundness Index (BRI)

Biochemical Tests:

Fasting glucose, HbA1c, lipid profile (HDL, LDL, total cholesterol, triglycerides), creatinine, estimated glomerular filtration rate (eGFR)

Clinical History:

Presence or absence of diagnosed diabetes, hypertension, or chronic kidney disease

History of major cardiovascular events

Methods Study Design and Setting This is a descriptive, community-based field study to be conducted among individuals registered at the Bağlarbaşı Family Health Center, located in the Şahinbey district of Gaziantep, Türkiye. The primary aim of the study is to determine the prevalence of Cardiovascular-Kidney-Metabolic (CKM) Syndrome stages (Stage 0 to 4) among individuals aged 30 to 79 years, and to evaluate the association of these stages with SCORE-2 risk scores and anthropometric indicators.

• Association between CKM stages and SCORE-2 risk scores, BRI [Time frame: At the time of enrollment (single visit)]