Being in your early 20s might seem far too young to worry about heart disease. But new research suggests that some of the risk factors that eventually damage the heart and arteries may already be taking shape decades before most people would think to look for them.
A study published in August 2026 in Circulation: Population Health and Outcomes examined 1,283 young adults with an average age of just 23. Researchers found that nearly 80% already met the criteria for at least Stage 1 cardiovascular-kidney-metabolic (CKM) syndrome, a framework that brings together cardiovascular, kidney and metabolic health.
Only 20.7% of participants had no identifiable CKM risk factors. The remaining 79.3% had at least excess or dysfunctional body fat, metabolic risk factors, or more advanced signs of CKM syndrome. More concerning, when researchers looked at participants in the higher stages, ultrasound imaging revealed differences in the walls of their carotid arteries associated with the early development of atherosclerosis.
Study author Donald Lloyd-Jones said the researchers’ two approaches, CKM syndrome staging and the American Heart Association’s Life’s Essential 8 score, were “complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury, plaque build-up and, ultimately, at higher risk for future cardiovascular events.”
What Is CKM Syndrome – and Why Does It Have a New Name?
The American Heart Association formally defined cardiovascular-kidney-metabolic (CKM) syndrome in 2023 as a unified condition combining metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Previously, clinicians tended to treat these conditions separately – cardiologists managing the heart, nephrologists the kidneys, and endocrinologists metabolic disease. The CKM framework recognizes that damage in one of these systems accelerates dysfunction in the others.
The syndrome is categorized in five stages. Stage 0 represents optimal health with no risk factors. Stage 1 is defined by excess or dysfunctional adiposity. Stage 2 includes metabolic risk factors such as high triglycerides, elevated blood glucose, or high blood pressure, or the presence of kidney disease. Stage 3 represents subclinical cardiovascular disease or high-risk equivalents without symptoms. Stage 4 represents established cardiovascular conditions such as coronary heart disease, heart failure, or stroke.
The FF-CHAYA Study: What Researchers Found in 23-Year-Olds
The FF-CHAYA study, published in Circulation: Population Health and Outcomes, analyzed health data from 1,283 participants with a mean age of 22.9 years. The cohort was drawn from an ancillary of the Future of Families and Child Well-Being Study, which intentionally included many participants from lower socioeconomic backgrounds through oversampling of disadvantaged families, a design choice that may mean prevalence figures skew higher than they would in a nationally representative sample of young adults.
Of the 1,283 participants, 20.7% were classified as Stage 0 CKM with no risk factors. The remaining 79.3% fell into Stage 1 or higher: 40.2% in Stage 1 (excess or dysfunctional adiposity), 36.2% in Stage 2 (metabolic or kidney risk factors), and 2.8% in Stage 3 (subclinical cardiovascular disease or advanced kidney disease). None were in Stage 4.
Lloyd-Jones noted that the research team “was surprised that only 20% of these young adults had healthy weight, healthy fat distribution, normal kidney function, and no metabolic risk factors.”
Arterial Damage Already Visible at 23
Researchers assessed arterial health using ultrasound imaging of the carotid arteries, large vessels in the neck that carry blood to the brain. Carotid artery wall thickness measured by ultrasound is an established proxy for atherosclerosis – the progressive buildup of fatty plaques inside artery walls – and provides an early indicator of cardiovascular risk before symptoms develop.
Participants with more advanced CKM syndrome stages showed thicker carotid artery walls, consistent with early arterial injury. The researchers concluded that cardiovascular disease prevention efforts need to begin earlier in life, given that atherosclerotic changes were measurable in a population with an average age of 23.
The Biology: How Three Diseases Reinforce Each Other
Excess fat tissue is not metabolically inert. It releases inflammatory signaling molecules, promotes insulin resistance – a state in which cells stop responding properly to insulin, pushing blood sugar levels higher – and alters the hormonal environment in ways that put both the kidneys and cardiovascular system under persistent physiological stress.
Excess adiposity promotes kidney injury through hemodynamic, metabolic, and inflammatory pathways, including glomerular hyperfiltration – where the kidney’s filtering units are forced to work abnormally hard – and activation of the renin-angiotensin system, a hormonal cascade that regulates blood pressure and, when chronically overactivated, damages kidney tissue and arterial walls.
A study published in the International Journal of Molecular Sciences found that obesity and chronic kidney disease form a vicious cycle in which inflammation is the central axis of multiorgan damage, with obesity accelerating atherosclerosis through insulin resistance and inflammatory mechanisms.
The Adiposity Numbers in the Study
Roughly 40% of the young adult participants already carried excess or unhealthily distributed weight, placing them at Stage 1 CKM or higher from that factor alone. Excess adiposity at Stage 1 does not require a clinical obesity diagnosis – dysfunctional fat distribution, such as visceral adiposity concentrated around the abdominal organs, can trigger the same inflammatory and hormonal disruptions even when overall body weight appears normal by standard metrics.
Life’s Essential 8: The Second Measure the Researchers Used
Beyond CKM staging, the research team assessed participants using Life’s Essential 8, the American Heart Association’s cardiovascular health scorecard. The Life’s Essential 8 framework, published in Circulation, comprises eight health behaviors and biological measures: diet quality, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure.
Young adults with more advanced CKM syndrome stages had lower cardiovascular health scores across this framework. The correlation between poorer Life’s Essential 8 scores and more advanced CKM staging confirmed that the two systems measure overlapping but complementary aspects of cardiovascular health. Lloyd-Jones described both tools as “complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury.” The practical implication is that both measures should be applied to young adult patients – not reserved for those aged 30 or older already managing documented risk factors.
The Screening Gap for Young Adults
The AHA’s PREVENT calculator – the primary clinical tool for estimating cardiovascular risk – is validated for adults aged 30 to 79 without known cardiovascular disease. The FF-CHAYA participants fall below that age floor, meaning standard clinical risk calculation tools were not designed for this age group.
Young adults without a known chronic disease rarely receive comprehensive metabolic or kidney function panels during routine care. Blood pressure may be checked, but a lipid panel, fasting glucose, and kidney function markers – the tests needed to fully stage CKM syndrome – are not standard practice for a 23-year-old without obvious risk factors. The FF-CHAYA findings raise concerns about CKM going undetected for years in this population, the study authors noted.
The study itself carries important methodological constraints. Its cross-sectional design captures a single point in time rather than tracking participants over years, so it shows association but cannot establish cause and effect. Because the study population intentionally included many individuals from disadvantaged backgrounds, the findings may not be fully generalizable to all young adults. The researchers called for additional long-term studies to determine how CKM syndrome stage in young adulthood relates to future cardiovascular disease risk.
Type 2 Diabetes: A Growing Concern in This Age Group
Type 2 diabetes, once associated almost exclusively with middle-aged and older adults, is now appearing with increasing frequency in people in their 20s and 30s. As a Stage 2 CKM risk factor, it carries cardiovascular implications that begin accumulating well before standard screening tools are designed to detect them. The earlier metabolic disruption begins, the longer the arteries are exposed to the downstream effects of insulin resistance, elevated triglycerides, and glucose-driven inflammation – compounding risk across decades.
You can read more about how CKM risk factors compound over time in this related coverage: You May Be One of the 90% of U.S. Adults Who Have a Syndrome That Most Have Never Heard Of.
What the Findings Mean in Practice
For young adults, the FF-CHAYA findings reframe the relevant clinical question. Rather than asking whether cardiovascular disease is present, a more useful question for someone in their early 20s is where they fall on the CKM spectrum – and whether lifestyle factors in the near term can prevent progression to a more advanced stage.
The eight metrics tracked by Life’s Essential 8 – diet quality, physical activity, nicotine avoidance, sleep duration, body weight, blood lipid levels, blood glucose, and blood pressure – provide a practical personal checklist. All eight are modifiable. For a 23-year-old already carrying excess adiposity, attention to sleep, diet, physical activity, and weight management represents stage-relevant action that may reduce the likelihood of progressing to Stage 2 or beyond.
For clinicians, the study adds to a growing body of evidence that meaningful primary prevention needs to begin before age 30. Discussing metabolic and kidney health markers at routine appointments with young adult patients – rather than waiting for symptoms to appear – is consistent with what the FF-CHAYA data show about how early arterial damage accumulates.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
Read More: Gout in Young Men Is Surging — Here’s What Scientists Have Found