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What This Means For You

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Stage 3 means your heart or blood vessels are starting to show early signs of disease—even if you feel fine. You may not have symptoms, but tests are showing changes that suggest your heart is under stress or your arteries are narrowing. This stage is sometimes called “subclinical cardiovascular disease” because the damage is happening silently. You might be in Stage 3 if:

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• A heart scan shows plaque buildup in your arteries (like a coronary artery calcium score)

• Blood tests show early heart strain (like high BNP or troponin levels)

• Heart imaging reveals subtle problems with structure or function

• You have very high-risk chronic kidney disease

• Or your doctor calculates that you’re at high risk of a heart attack or stroke

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Stage 4 means you’ve been diagnosed with a serious heart or blood vessel condition—and possibly advanced kidney disease. At this point, the damage is no longer silent or early. These are clinical, diagnosed conditions that need careful treatment and regular monitoring. You may be in Stage 4 if you have:

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• A heart attack or angina (chest pain)

• Stroke or mini-stroke (TIA)

• Peripheral artery disease (circulation problems in your legs)

• Heart failure

• Irregular heartbeat (like atrial fibrillation)

• Advanced chronic kidney disease or kidney failure

• Or a combination of multiple CKM-related conditions

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Heart Failure

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Heart failure means the heart isn’t pumping blood as well as it should. It doesn’t mean your heart has stopped—it means it’s struggling to keep up with your body’s needs.

There are two main types:

• Heart Failure with Preserved Ejection Fraction (HFpEF) – more common with obesity and high blood pressure

• Heart Failure with Reduced Ejection Fraction (HFrEF) – more often linked to heart attacks or other damage

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You may experience symptoms like:

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• Shortness of breath (especially when lying down or walking)

• Swelling in the legs or feet

• Fatigue or trouble with everyday tasks

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If you have kidney disease and heart failure together, it's even more important to manage your fluid balance, medications, and follow-up appointments carefully.

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Other Cardiovascular Conditions in Stage 4

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This stage may also include:

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• Heart disease (including previous heart attacks and narrowed arteries)

• Stroke and TIA (caused by blocked blood flow to the brain)

• Peripheral artery disease (reduced blood flow to the legs)

• Atrial fibrillation (AFib) – an irregular heart rhythm that increases stroke risk

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These conditions are often made worse by other CKM factors like diabetes, high blood pressure, or obesity. Having more than one of these issues increases your risk of future heart problems, hospital visits, and complications.

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Kidney Failure (Stage 4b)

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Some patients in Stage 4 also have kidney failure, where kidney function is severely reduced. This adds another layer of complexity to managing your care—especially when combined with heart disease. People with both CVD and kidney failure are at very high risk for complications.

Care at this stage focuses on:

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• Managing medications safely

• Controlling fluid buildup and blood pressure

• Preparing for treatment options (like dialysis, if needed)

• Coordinated care between your heart and kidney teams

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