Features of Lipid Disorders in Cardiovascular–Kidney–Metabolic Syndrome
Year: 2026
Type: review
Abstract: Cardiovascular-kidney-metabolic (CKM) syndrome is driven by the interplay of visceral adiposity, insulin resistance, chronic inflammation, oxidative stress, and progressive kidney dysfunction. These mechanisms generate a distinct atherogenic dyslipidaemic phenotype characterised by elevated triglycerides (TG), reduced high-density lipoprotein-cholesterol (HDL-C), increased apolipoprotein B (apoB)-containing lipoproteins, remnant cholesterol (RC) accumulation, small dense low-density lipoprotein (LDL) particles, and frequently elevated lipoprotein(a) [Lp(a)]. Such lipid abnormalities contribute to accelerated atherosclerosis and early renal deterioration. In turn, kidney dysfunction further amplifies lipid abnormalities. These pathways underscore the need for a timely and comprehensive lipid assessment using apoB, non-HDL-C, RC, and Lp(a) within the CKM framework. Effective lipid management is crucial for CKM syndrome treatment, with the potential to reduce residual cardiovascular and renal risk and improve long-term clinical outcomes. In this narrative review, we examine current evidence on the pathophysiological mechanisms underlying CKM-related dyslipidaemia and provide a practical framework for its assessment and management. Management requires a multimodal approach tailored to the patient's lipid phenotype and overall cardiovascular risk, incorporating a range of lipid-lowering strategies including statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, icosapent ethyl, and emerging therapies targeting apoC-III, ANGPTL3, and Lp(a). Beyond lipid lowering, lifestyle interventions and cardiometabolic therapies such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and finerenone may provide complementary cardiometabolic and renal protection.
DOI: 10.3390/ijms27188317
Authors: Alexandr Ceasovschih, Yusuf Ziya Şener, Mustafa Arici, Mariia Cherska, Vanessa Bianconi, Malik Ejubović, Stanislav Kotlyarov, Vladimir Ristovski, Ahmet Yetkin, Pelin Golforoush, Tatyana Storozhenko, Fotios Barkas, Alexandru Corlateanu, Pradeesh Sivapalan, Tea Gamezardashvili, Antonio M. Gotto, Laurentiu Sorodoc, Victorita Sorodoc
Institutions: Grigore T. Popa University of Medicine and Pharmacy, Erasmus MC, Hacettepe University, V.P. Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, University of Perugia, University of Zenica, Ryazan State Medical University named after Academician I.P. Pavlov, Sivas State Hospital, The Francis Crick Institute, L.T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine, Onze Lieve Vrouwziekenhuis Hospital, University of Ioannina, Nicolae Testemițanu State University of Medicine and Pharmacy, University of Copenhagen, Copenhagen University Hospital, Gentofte Hospital, Cornell University, Weill Cornell Medicine
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7214469925