Rechristen 'Cardiovascular-Kidney-Metabolic (CKM)' health to 'Cardiovascular-Kidney-Liver-Metabolic (CKLM)' health: Bridge the Gap.

The burden of cardiovascular diseases (CVDs) has markedly increased over the last few decades and has emerged as a leading cause of death in the world. A recent presidential advisory from the American Heart Association has proposed the concept of Cardiovascular- Kidney-Metabolic (CKM) health to emphasize the burden of CVD and its associated morbidities. The CKM is a four-stage continuum of progressively worsening metabolic dysfunction, which is associated with increasing CVD risk along the spectrum. Unfortunately, the proposed concept missed to recognize the importance of metabolic dysfunction-associated steatotic liver disease (MASLD) in the development and progression of CVD and chronic kidney disease (CKD). Evidence from meta-analyses and cohort studies shows that MASLD, which has its origin in metabolic dysfunction, is strongly associated with CKM health and also accelerates CVD and CKD-associated mortality. In this piece of writing, we proposed to rechristen the 'CKM health' to 'CKLM health' by incorporating the MASLD as a marker of liver health and also proposed the framework for CKLM staging. This proposed conceptual correction reflects biological and physiological reality, strengthens risk prediction, and integrates multi-organ care. Expanding CKM to CKLM is necessary to overcome fragmented care and align prevention and treatment efforts for major metabolic disorders.