Vietnam's Heart, Kidney and Metabolic Disease Burden Calls for Earlier, Coordinated Care

A national burden meets a warning from Ho Chi Minh City

Cardiovascular disease, diabetes and kidney disease are linked to more than 40% of deaths in Vietnam, according to national figures cited in Vietnamese health reporting. A separate study of 480 adult outpatients in Ho Chi Minh City offers a more focused warning: seven of the 24 people with both chronic kidney disease and coronary artery disease died within five years, a mortality proportion of 29.2%.

The figures describe different things. The national estimate concerns causes of death across the population. The outpatient study measured deaths from any cause in a selected clinical group. Neither establishes that a single condition called cardiovascular, kidney and metabolic syndrome, or CKM, directly caused all those deaths.

What connects them is a growing approach to care: heart disease, kidney damage and metabolic problems such as diabetes should be assessed together because they frequently coexist and can accelerate one another.

The national breakdown attributes more than 23% of deaths to stroke, 9.2% to ischemic heart disease, 4.4% to diabetes and 3.3% to kidney disease. Ischemic heart disease develops when the heart muscle receives too little blood, commonly because its arteries have narrowed. Using 23% for stroke gives a combined 39.9%; the reported stroke share is higher, but the rounded figures do not establish an exact combined percentage. The year and underlying national dataset are not identified in the account presenting these estimates.

Noncommunicable diseases are also described as accounting for 78% of Vietnam's disease burden. Disease burden measures the population's loss of health, rather than simply counting deaths, so that percentage should not be treated as another mortality figure.

What CKM changes about the way disease is understood

The American Heart Association introduced its CKM framework in a 2023 Presidential Advisory. It brings excess body fat, metabolic risk, chronic kidney disease and cardiovascular disease into one approach to prevention and treatment, instead of waiting for each problem to become a separate specialist diagnosis.

In a February 1, 2024, UT Southwestern explanation, Amit Khera, director of Preventive Cardiology and clinical chief of Cardiology, described the reasoning behind the advisory. Khera served on its writing group alongside Sonali S. Patel, an associate professor of pediatric cardiology.

Khera described the earlier pattern of care as treating the connected conditions separately, often after organ damage had occurred:

Providers have historically had to approach this web of conditions by separating the sum into its parts – spotting and treating the individual diseases separately, often after damage had been done to the patient’s heart and kidneys.

The National Kidney Foundation's patient education guidance, updated March 2, 2026, makes a useful distinction: CKM is a framework describing connected health problems, not a standalone disease diagnosed with one test. Its explanation also includes fatty liver disease, obesity, high triglycerides and irregular heart rhythms among the connected conditions.

Why damage in one organ can affect another

Heart, kidney and metabolic disorders share several biological processes. Persistent inflammation, insulin resistance, oxidative stress and damage to the lining of blood vessels can contribute to their progression. Insulin resistance means the body responds less effectively to the hormone that helps regulate blood sugar. Oxidative stress occurs when reactive molecules overwhelm the body's protective mechanisms and damage cells.

Excess body fat, high blood pressure, abnormal blood fats and diabetes can promote damage to blood vessels. That can lead to artery narrowing, heart attack, stroke, heart failure and kidney impairment. Once one organ is affected, managing the others becomes more complicated.

Figures cited in Vietnamese clinical reporting illustrate the overlap: about 40% of people with type 2 diabetes have chronic kidney disease; 44% of patients hospitalized for heart failure have diabetes; and nearly half of people with heart failure have reduced kidney function. These percentages concern different patient groups and should not be added together or treated as national prevalence estimates.

Vietnam's undiagnosed diabetes gap

The Ministry of Health has been cited as estimating that Vietnam has seven million people with diabetes, about half of whom have not been diagnosed. If that estimate holds, roughly 3.5 million people may be living with the condition without a formal diagnosis, delaying assessment of related heart and kidney risks.

At the 11th expanded Hanoi conference on endocrinology, diabetes and metabolic syndrome on October 18, Associate Professor Do Trung Quan, president of the Hanoi Endocrinology and Diabetes Association, discussed the rapid growth of diabetes and the damage that can develop unnoticed. The conference account does not specify the year.

Figures presented alongside that discussion indicated that 55% of people with diabetes had complications, including cardiovascular complications in 34%, eye and nerve complications in 39%, and kidney complications in 24%. These categories can overlap: one person can have several complications, so their percentages are not a partition of the 55% total.

The same account cited a fivefold heart failure risk among people with diabetes and a five year mortality figure of 50%. It did not clearly define the patient group underlying the mortality estimate. That figure should not be interpreted as a prediction that half of everyone with diabetes will die within five years.

It also described diabetes prevalence among adults aged 20 to 79 as having tripled since 2000 and related medical costs as having tripled over 15 years, without providing the full measurement periods. The International Diabetes Federation figures cited there, 537 million adults worldwide and a projection of 783 million by 2045, represent an increase of 246 million, or about 46%. They are historical estimates and a projection, not a current global count.

Five stages, with different opportunities to act

The AHA framework has five stages, numbered 0 through 4. Stage 0 means no identified CKM risk factors. Stage 1 concerns excess body fat, including fat around the waist or within organs, before established diabetes, kidney disease or cardiovascular disease. Khera's explanation also places early problems such as prediabetes in this stage.

Stage 2 includes metabolic risk factors or kidney disease, such as high blood pressure, diabetes and abnormal blood fats. Stage 3 concerns cardiovascular disease detectable through testing before clear symptoms, or very high cardiovascular risk. Stage 4 means established cardiovascular disease, including heart attack, stroke, heart failure, peripheral artery disease or atrial fibrillation.

The institutional explanations differ in some details. Khera's overview includes advanced kidney disease under Stage 4. The National Kidney Foundation places Stage 4 or 5 chronic kidney disease, and some Stage 3 kidney disease depending on urine albumin levels, within CKM Stage 3. Kidney disease stages and CKM stages are different numbering systems. A patient with Stage 4 kidney disease does not automatically have Stage 4 CKM.

These differences make individualized clinical assessment more useful than assigning a stage from a short checklist. The central message is consistent: the absence of symptoms does not exclude substantial risk.

What the Vietnamese outpatient study actually found

The Vietnamese outpatient study, by Duc Khanh Nguyen, Thanh Tuan Tran and Van Sy Hoang, examined adults recruited at Ho Chi Minh City outpatient clinics during 2016. Researchers accessed the deidentified dataset on March 31, 2024. Most participants, 331 of 480, were aged 40 to 60.

The study used four practical categories based on recorded diagnoses. The authors explicitly state that these are not official AHA CKM stages:

• Category A: no documented metabolic risk diagnosis, chronic kidney disease or coronary artery disease, 24 participants.
• Category B: hypertension, diabetes or abnormal blood fats, without documented kidney or coronary disease, 252 participants.
• Category C: kidney disease or coronary artery disease, but not both, 180 participants.
• Category D: both chronic kidney disease and coronary artery disease, 24 participants.

There were 64 deaths within the five year analysis period, representing 13.3% of participants. The proportions were zero of 24 in Category A, 33 of 252 in Category B, 24 of 180 in Category C and seven of 24 in Category D.

Mortality in the combined kidney and coronary disease group was about 2.2 times the proportion in Category C, 29.2% compared with 13.3%, a difference of approximately 15.9 percentage points. Categories B and C had very similar observed mortality, so the findings do not show a smooth increase across every category.

After adjustment for age group and sex, Category D had an odds ratio of 2.87 compared with Categories A and B combined. An odds ratio is a statistical comparison of the odds of an event, not a direct multiplier of an individual's probability of dying. Its 95% confidence interval, 1.04 to 7.94, was wide, reflecting substantial uncertainty.

Why the findings need cautious interpretation

Only 24 participants had both kidney and coronary disease. Half were older than 60, and all seven deaths in this category occurred among those 12 older participants. None had documented diabetes at baseline. The findings therefore concern combined kidney and coronary disease, not exclusively the combination of diabetes, heart disease and kidney disease.

The study lacked urine albumin measurements, waist circumference, systematic testing for hidden cardiovascular disease, medication information and causes of death. Undiagnosed conditions could have affected category assignments. Its single urban setting also limits how confidently the results can be applied across Vietnam.

The authors replaced an earlier claim of a fixed ten year mortality outcome with a five year endpoint and reanalyzed the data. They provide analysis code and a dataset with additional privacy protections through Zenodo, identified by DOI 10.5281/zenodo.20499122.

Associate Professor Thai Minh Sam, vice president of the Ho Chi Minh City Urology and Nephrology Association, has also discussed a retrospective Chinese study of more than 33,000 people followed for five years, describing higher mortality at more advanced CKM stages. That supports concern about combined disease, but the account does not provide enough numerical detail for a direct comparison with the Vietnamese cohort.

The sequence of developments also helps distinguish older patient data from newer guidance:

• 2016: the Ho Chi Minh City outpatient cohort was recruited.
• 2023: the AHA introduced its CKM Presidential Advisory.
• February 1, 2024: Khera published UT Southwestern's explanation.
• March 31, 2024: researchers accessed the Vietnamese cohort dataset.
• March 2, 2026: the National Kidney Foundation updated its patient guidance.

Screening goes beyond blood sugar

CKM assessment can include blood pressure, weight, waist size, blood glucose, cholesterol and kidney function. The estimated glomerular filtration rate, or eGFR, estimates how effectively the kidneys filter blood. The urine albumin to creatinine ratio, or uACR, detects leakage of a protein into urine, which can signal kidney damage.

The National Kidney Foundation also lists A1C, which reflects average blood sugar over recent months, and BNP or NT-proBNP, markers of heart strain. Depending on risk and symptoms, clinicians may use an electrocardiogram, echocardiogram or other heart tests. Not everyone needs every test.

Sam described coronary artery calcium scoring, the ankle to brachial blood pressure index, NT-proBNP, sensitive troponin testing and echocardiography as tools for detecting cardiovascular problems before major events. The ankle to brachial index compares blood pressure at the ankle and arm to help identify poor circulation in the legs.

The PREVENT equations assess cardiovascular risk in adults aged 30 to 79 and incorporate kidney function, with additional information such as A1C and urine albumin potentially informing the assessment. Such estimates support clinical decisions; they do not prove that an event will happen or replace investigation of symptoms.

Treatment aims to protect both heart and kidneys

Dr. Dang Khoi Nguyen, of the Endocrine and Nephrology Unit at Le Van Thinh Hospital in Ho Chi Minh City, describes treatment as starting with lifestyle changes, weight management and control of blood sugar, blood pressure and blood fats. Medication selection then depends on the person's conditions, kidney function and risk.

SGLT2 inhibitors, originally developed for diabetes, can protect kidney function and reduce heart failure events in appropriate patients, including some without diabetes. The EMPA-KIDNEY trial has been cited in Vietnamese clinical discussion as supporting benefits in chronic kidney disease with low filtration rates, including some patients without albuminuria. That does not mean every patient with kidney disease is eligible for the same treatment.

GLP-1 receptor agonists can support blood sugar control and weight loss, with cardiovascular and kidney benefits for suitable patients. Other options described by the institutional guidance include statins, PCSK9 inhibitors, medicines acting on the renin, angiotensin and aldosterone system, mineralocorticoid receptor antagonists and ARNIs. These classes have different indications and are not a universal prescription package.

Kidney function can also restrict treatment. The National Kidney Foundation states that metformin may require a lower dose in chronic kidney disease and is generally avoided when eGFR is below 30. Aspirin, anticoagulants and diuretics likewise require specific clinical reasons rather than routine use by everyone with CKM risk.

Prevention advice is concrete: UT Southwestern recommends at least 150 minutes of moderate activity or 75 minutes of vigorous activity weekly, plus strength training twice a week. The kidney foundation suggests aiming for 30 minutes most days if able, starting gradually and checking with the care team before a new routine.

Nutrition advice includes limiting salt, sugary drinks and processed foods. People with kidney disease may need individual guidance on potassium, phosphorus and protein rather than a generic diet. Coordinated appointments and shared information among cardiology, kidney and diabetes teams can help keep these recommendations consistent.

The Vietnamese cohort establishes an association, not proof that a particular CKM treatment strategy reduces deaths. The authors call for larger prospective studies with complete assessment and standardized follow-up. No date is given for that validation or for a nationwide Vietnamese CKM program.

Key Points

• Vietnamese health reporting links cardiovascular disease, diabetes and kidney disease to more than 40% of national deaths, but the underlying dataset and year are unspecified.
• A Ho Chi Minh City cohort recorded 64 deaths among 480 outpatients over five years.
• Seven of 24 participants with both kidney and coronary disease died, the highest observed mortality proportion.
• The study's four categories are not official AHA CKM stages, and its small highest burden group limits precision.
• CKM care combines assessment of metabolic, kidney and cardiovascular risk rather than focusing on blood sugar alone.
• Screening, lifestyle measures and medicines should be selected according to individual risk and kidney function.