The CRM Syndrome:
Understanding the Connected Crisis
A resource hub on cardiorenal metabolic syndrome in Malaysia.
What is Cardiorenal Metabolic (CRM) Syndrome?
CRM syndrome, also referred to as Cardiovascular-Kidney-Metabolic (CKM) Syndrome, was formally defined by the American Heart Association in 2023. It goes beyond the idea of separate conditions occurring together. Instead, it recognises that heart disease, kidney disease, diabetes, obesity, and hypertension interact through complex biological pathways with each condition accelerating and compounding the others.
Instead of managing these conditions in isolation, the CRM framework calls for a holistic, whole-body approach to prevention, early detection, and treatment. It shifts focus from end-stage complications toward early intervention along the entire disease continuum.
Cardiovascular Disease
Heart disease, heart failure, stroke, coronary artery disease, and atrial fibrillation are major downstream outcomes of CRM syndrome. Poorly controlled diabetes and hypertension damage blood vessels and the heart muscle over time, accelerating cardiovascular risk.
Kidney Disease
Diabetes and hypertension account for nearly 80% of all chronic kidney disease (CKD) cases. As kidney function declines, blood pressure becomes harder to control, further straining the heart. A vicious cycle that drives CRM syndrome progression.
Metabolic Conditions
Obesity, type 2 diabetes, dyslipidaemia (high cholesterol), and insulin resistance are the upstream drivers of CRM syndrome. Excess abdominal fat triggers inflammation and hormonal disruption, setting off cascades that damage the heart, blood vessels, and kidneys.
Signs, Screening & Risk
CRM syndrome often develops silently. Risk factors include high blood pressure, elevated blood sugar or HbA1c, abnormal kidney function tests (eGFR, albuminuria), obesity (especially central), high triglycerides, and a family history of heart or kidney disease.
Framework
The Four Stages of CRM Syndrome
CRM syndrome is made of four progressive stages based on risk factor burden and organ involvement. Earlier staging means greater opportunity for prevention and reversal.
Excess Adiposity
Overweight or obesity, with or without metabolic dysfunction. No diabetes or kidney disease yet.
Metabolic Risk & Kidney Disease
Hypertension, diabetes, dyslipidaemia, and/or moderate-to-high-risk CKD present. Cardiovascular risk is high.
Subclinical Cardiovascular Disease
Early, asymptomatic heart or vascular damage detected alongside CRM risk factors.
Clinical Cardiovascular Disease
Established heart failure, coronary disease, stroke, or peripheral artery disease alongside metabolic and/or kidney conditions.
CRM Syndrome in Malaysia
Malaysia faces a "perfect storm" of lifestyle risk, and dietary patterns that make its population particularly vulnerable to CRM syndrome. Over 2.3 million adults are already living with three or more of the risk factors. The numbers are steadily rising.
High NCD Burden & Co-occurrence
According to the NHMS 2023, 16% of adults have diabetes, 29% have hypertension, and 33% have high cholesterol. Over 2.3 million live with three of these conditions simultaneously. 500,000 people are with all four including obesity.
Diabetes Epidemic Driving Kidney Failure
Malaysia has the highest diabetes rate in the Western Pacific region. Diabetics are 3.5 times more likely to develop CKD. Over 65% of new end-stage kidney disease cases are linked to diabetes, and Malaysia has the second-fastest rising kidney failure rate globally.
Silent Disease — Low Awareness
Only 5% of the 5 million Malaysians with CKD are aware of their condition. Nearly half of all people with diabetes in Malaysia remain undiagnosed.
Fragmented, Siloed Treatment
Conditions within CRM syndrome are routinely managed by different specialists with limited coordination. Experts warn this fragmented approach is both clinically ineffective and more expensive than integrated, holistic care.
Genetic & Dietary Vulnerability
Malaysians face heightened susceptibility due to genetic predisposition in Malay, Chinese, and Indian ethnic groups, combined with high-carbohydrate diets, sedentary lifestyles, and rapid urbanisation — compounding CRM syndrome risk from a young age.
Escalating Economic Cost
Diabetes alone costs Malaysia approximately RM3.1 billion annually. With over 10,000 new dialysis patients per year and cardiovascular disease among the top causes of death, the cumulative cost of CRM syndrome on Malaysia's healthcare system is enormous and growing.
Ongoing projects
A consensus document is intended to help provide policy guidance on areas such as screening and risk stratification, referral and care pathways, treatment and financing. It utilises and is guided by current CRM related data, challenges and unmet needs, and encourages interdisciplinary approaches, increases resources, and encourages collaboration.
The Galen Centre is currently working on the development of a consensus document for cardiovascular renal metabolic syndrome in Malaysia.
Publications & Resources
Cardio-Renal Metabolic Summit 2024 (6-7 June 2024)
Briefs
Provides an overview of the landscape of cardiovascular renal metabolic in Malaysia, drawing on data from the National Health and Morbidity Surveys, Ministry of Health data, and published research.
Constituency Health Report Card for Bukit Bendera (P.048)
Event Reports
Public Forum – What is the urgency and relationship between diabetes and fatty liver disease in Malaysia? (12 December 2025)
Advisory Board – Responding to the Rising Challenge of Cardio-Renal-Metabolic (CRM) Syndrome in Malaysia (13 June 2025)
Roundtable Discussion – Managing the national cost of cardiorenal metabolic diseases: A focus on diabetes and stroke (20 September 2023)
Latest CRM Articles
24 November 2025
About the Galen Centre
The Galen Centre for Health and Social Policy is a Malaysian think tank dedicated to evidence-based health policy. This CRM syndrome microsite is part of our commitment to raising awareness of the interconnected burden of cardiorenal metabolic conditions in Malaysia.