KUALA LUMPUR, Nov 21 — Medical experts have highlighted the increasing development of cardiorenal metabolic (CRM) syndrome in Malaysia and how Malaysians are particularly vulnerable to this complex condition.
Prof Dr Rohana Abdul Ghani, senior consultant endocrinologist at Al-Sultan Abdullah UiTM Hospital (HASA), explained that CRM syndrome represents a continuum of dysfunctions of the heart, kidneys and some metabolic conditions, which are all interconnected.
“It emphasises that these conditions have overlapping risk factors, share the same pathway in the disease progressions, and require a combination of similar diagnostic criteria as well as management strategies,” Dr Rohana told CodeBlue.
“It shifts the focus from the end of the spectrum i.e. managing complications, to the early part of continuum i.e. obesity, dysglycaemia and elevated blood pressure, towards protecting the entire cardiorenal-metabolic axis, mitigating health burden, improving survival, reducing health care costs, and enhancing the overall quality of life.”
Dr Raja Ezman Faridz Raja Shariff, a consultant cardiologist, internal medicine physician, and head of the cardiology unit at HASA, stressed that CRM Syndrome is more than having multiple comorbidities.
“CRM or cardio-kidney-metabolic (CKM) syndrome goes beyond the tenet of having comorbidities causing a direct effect to cardiovascular health (e.g., diabetes leading towards heart attacks or strokes). Instead, research on the area focuses on the complex interplay between these comorbidities that oftentimes have a compounded effect on patients,” he told CodeBlue.
“We now appreciate that having the various linked conditions as a constellation worsens clinical outcomes by multi-fold, with exponential rise being documented in mortality and morbidity.
“In fact, the American Heart Association (AHA) and other major international cardiovascular societies have since recognised the need for classification of CRM syndrome, and have recently proposed CKM health staging (i.e., stages 0 to 4) to objectively gauge patient’s overall risk, as opposed to risk predictions based on individual conditions which would lead to significant underestimation.”
According to the International Diabetes Federation, cardiovascular, renal, and metabolic conditions are intricately linked conditions with overlapping pathogeneses and include the following conditions: chronic kidney disease (CKD), heart failure, Type 2 diabetes mellitus, obesity, and metabolic dysfunction-associated steatohepatitis (MASH).
Why Malaysians Are Especially Vulnerable To CRM Syndrome
Malaysia, with a high prevalence of chronic diseases like diabetes, hypertension, and high cholesterol, has a particular challenge with CRM syndrome.
“Malaysians face a perfect storm of genetic, lifestyle and dietary risks that make us especially vulnerable to CRM syndrome,” said Dr Rohana.
“Asians in general, tend to develop diabetes and high blood pressure at lower body mass index (BMI), and at younger age. This means that various organs including the heart, kidneys and liver are exposed to years of silent metabolic stress before symptoms appear.”
Such silent damage leads to late-stage diagnoses when complications are advanced.
“In addition, our obesogenic environment of diets, which are rich in refined carbohydrates, sugar and salt, combined with our increasingly sedentary urban lifestyles are the perfect recipe for disaster.”
Dr Raja Ezman Faridz similarly said Malaysians are at a particularly high risk of developing CRM syndrome due to the “significantly high” rates of diabetes, obesity, and CKD in the population.
“Furthermore, the development of CRM syndrome in Malaysia is particularly rampant as early screening and optimum risk factor control remains underwhelming at present, which allows for various components to progress.”
According to the National Health and Morbidity Survey (NHMS) 2023, more than two million adults in Malaysia are living with three non-communicable diseases (NCDs) among diabetes, hypertension, high cholesterol, or obesity. More than half a million people are living with all four chronic diseases.
About 53.5 per cent of the Malaysian population is overweight or obese; some 22.2 per cent are obese, based on the National Health Screening Initiative (NHSI) 2023.
At least 15.5 per cent of the Malaysian population, or more than five million people, are living with CKD. Over 51,000 people in Malaysia currently live with end-stage renal disease (ESRD); Malaysia’s incidence rate for ESRD is among the highest in the world.
Patients, General Public Should View CRM Syndrome As Own Entity
Dr Raja Ezman Faridz urged patients and the general public to view CRM syndrome as an entity of its own to allow for better management of their conditions.
He explained that for example, there used to be a huge focus on controlling blood sugar in patients with diabetes to strive for good haemoglobin A1C (HbA1C) levels.
“Although HbA1C remains an important tool, there has since been a paradigm shift in the management of metabolic health going beyond that of HbA1C, which now incorporates assessment and improvement of overall risk for cardiovascular and kidney outcomes as well,” said the cardiologist and internal medicine physician.
“This is why new-age pharmacotherapeutic agents such as that of sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and non-steroidal mineralocorticoid receptor antagonists (nsMRAs) have seen favourable response over the past decade or so.”
Health Minister Dzulkefly Ahmad told reporters last month that Budget 2026 allocated an additional RM21 million from sugar-sweetened beverage (SSB) tax revenue for the procurement of SGLT2 inhibitors to treat kidney disease and diabetes.
“Patients need to understand that obesity, diabetes, heart disease and kidney disease are not separate illnesses, but part of one interconnected process,” said Dr Rohana.
“When people understand that obesity leads to high sugar, blood pressure and the development of heart and kidney diseases later in life, then this would empower them to work on treating all these medical conditions to prevent the complications.
“Awareness and understanding will change attitudes from a reactive act into preventive actions.”
NP-MY-100148
