如今的医疗系统高度专科化，似乎每个医生都对应着专门的器官。心脏不舒服时我们会去看心血管病医生，肾脏出了问题会去找肾病科医生，如果患有糖尿病或其他与激素相关的问题，会去看内分泌科医生。但事实证明，这些器官或健康问题之间联系紧密，肾脏问题和新陈代谢问题会增加心血管疾病的风险，例如心脏病、动脉堵塞等。高度专科化可能会让医生看不到全局风险，美国西北大学（Northwestern University）的心脏病学家萨迪娅汗（Sadiya Khan）便对此感到担忧：“写糖尿病指南的人提到了这一点，写肾脏指南的人提到了这一点，写心脏指南的人也提到了这一点。但实际上，一个病人不会去看三种不同的指南，临床医生也不会去看三种不同的指南。”因此，萨迪娅汗与肾脏和内分泌专家合作，帮助美国心脏协会（American Heart Association）编写了一套新的指南，定义了一种新的心脏病，名为心血管-肾脏-代谢综合征（cardiovascular-kidney-metabolic syndrome），简称 CKM 综合征。美国心脏协会称，三分之一的美国成年人至少拥有3个综合征风险因素。风险因素有很多，包括肥胖、高血压、高血糖，还有从肾脏血液中清除代谢废物的速度。当多个这样的因素同时存在时，它们会协同增加患心脏病或因心脏病过早死亡的风险。一个器官存在问题，是如何导致另一个器官出现问题的呢？肾脏和心脏之间存在很多不同的作用机制或相互影响，这要从肥胖说起。过多的脂肪细胞会分泌导致炎症的化学物质，从而伤害血管，损害心脏和肾脏组织。炎症还会降低细胞对胰岛素的敏感性，而胰岛素是一种能将血液中的糖分转移到细胞中的激素，血糖升高、细胞中的糖分减少，这也就是糖尿病的特征。心血管病医生早就知道肾脏和心脏之间的相互影响，萨迪娅汗认为，之所以现在才开始对这种情况进行治疗，其中一个关键驱动因素是人们意识到这些风险因素或病症的负担越来越重了，而且它们往往一起出现。肥胖症、糖尿病、肾脏疾病和心脏病的发病率在过去几十年中有所上升，如今，每个人患 CKM 综合征的风险都在增加。但萨迪娅汗还提到了另外一点……[查看全文]
A New Type of Heart Disease is on the Rise
Tanya Lewis: Today, we're talking about a newly recognized form of heart disease—CKM syndrome, which is when you have overlapping cardiovascular disease, kidney disease, and metabolic diseases like type 2 diabetes and obesity.Josh Fischman: We've got a highly specialized medical system. Sometimes it seems like each doctor has their own organ.Lewis: Right. Like if I had a heart problem, I'd go see a cardiologist.Fischman: And if my kidneys weren't healthy, I'd check in with a nephrologist.Lewis: Or if I had diabetes or some other hormone-related problem, I'd see an endocrinologist.Fischman: But it turns out that these organs, or health problems, have a lot to do with one another. In particular kidney problems and metabolic problems raise the risk for cardiovascular disease, which means everything from a heart attack to clogged arteries.Lewis: So all this medical specialization might keep a doctor from seeing the big-picture risk.Fischman: Exactly. And that's been worrying cardiologists like Sadiya Khan of Northwestern University.Khan: People who write diabetes guidelines write about that, people who write kidney guidelines write about that, people who write about heart guidelines write about that. But really, one patient isn't going to go to three different guidelines and clinicians aren't going to go to three different guidelines.Fischman: That's why Khan helped write a new set of guidelines from the American Heart Association, in collaboration with kidney and endocrine specialists. The guidelines, which were just released a few months ago, define a new form of heart disease called cardiovascular-kidney-metabolic syndrome.Lewis: That's a mouthful. There's gotta be a shorter way to say it.Fischman: There is. This is science and, after all, they love their abbreviations. So this is called CKM syndrome.Lewis: Much easier. How common is CKM?Fischman: The heart association says that one third of U.S. adults have at least 3 risk factors for the syndrome. There are many risk factors, and they include obesity, high blood pressure, high blood sugar. And from the kidneys, the rate they remove contaminants from the blood.Kahn: When these are present, and when more than one is present, they synergistically increase the risk of developing heart disease or dying prematurely from heart disease.Lewis: But how do problems in one organ drive problems in another?Fischman: I wondered the same thing. So I asked Khan, whose specialty is preventing heart and blood vessel disease. She spends a lot of time looking at the interplay between different organs.Khan: Oftentimes, people talk about how the kidneys and heart are like an old married couple. We've known for some time that having kidney disease increases your risk of developing heart disease. So there's this connection that exists. And the reverse is also true. Having heart disease makes you more at risk for having kidney disease.Lewis: I love the old married couple analogy. But what's the biology behind this shared risk?Khan: Yeah, there's lots of different mechanisms or crosstalk between the two different organs.Fischman: Basically, it starts with obesity. Excess fat cells secrete chemicals that cause inflammation. And that can harm blood vessels and damage both heart and kidney tissue. Inflammation also reduces cells' sensitivity to insulin, the hormone that moves sugar out of the blood and into those cells. More blood sugar, and less of it in cells, is the hallmark of diabetes, of course.Lewis: So in the old married couple analogy, if one spouse gets upset about something, it upsets their partner too? And the whole marriage fails?Fischman: Or they go in for counseling and work it out. In this case, I guess the counselor is a cardiologist.Lewis: Not to belabor the metaphor too much, but Kahn did say that cardiologists have known about this couple for a long time. So why are they just getting around to treating them now?Fischman: I asked Kahn that 'why now' question and this is what she said.Kahn: Yeah. I think one of the key drivers was the awareness that there's a growing burden of these risk factors or conditions, and they're often clustering together. So we know that the rate of obesity, diabetes, kidney disease and heart disease have increased in the past several decades.Fischman: So everyone is more at risk for CKM today. But Kahn also mentioned something else...[full transcript]
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