The American Heart Association and the American College of Cardiology, along with two other leading medical organizations, have issued the first-ever clinical practice guideline for cardiovascular-kidney-metabolic (CKM) syndrome, an interconnected set of health conditions that significantly increase the risk of multiorgan complications and negative cardiovascular outcomes. The guideline, published today in Circulation and JACC, details a staging system to assess how a person's kidneys, metabolism and heart are functioning, and provides comprehensive recommendations for screening, prevention and treatment.
According to the guideline, nearly 90% of U.S. adults have at least one CKM syndrome risk factor, including excess weight, high blood pressure, abnormal lipids, high blood glucose or reduced kidney function. Recent statistics indicate that 40% of U.S. adults and 21% of children and adolescents have obesity, which is a risk factor for high blood pressure, Type 2 diabetes, metabolic dysfunction, cardiovascular disease and kidney disease.
“Heart, kidney, and metabolic conditions don’t occur in isolation—they are deeply connected,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, chair of the guideline writing committee and director of obesity and cardiometabolic research at Johns Hopkins School of Medicine. “This guideline calls for earlier screening and care, focusing on prevention and coordinated action to reduce the risk of cardiovascular disease before serious complications develop or a major cardiac event occurs.”
The guideline defines four stages of CKM syndrome. Stage 1 includes individuals with overweight/obesity or prediabetes. Stage 2 includes those with metabolic risk factors such as high blood pressure, abnormal lipids, Type 2 diabetes or kidney disease. Stage 3 involves subclinical cardiovascular disease or very-high-risk chronic kidney disease. Stage 4 is diagnosed cardiovascular disease with metabolic risk factors or kidney disease.
Key recommendations include improved risk assessment using the PREVENT equations to estimate 10- and 30-year cardiovascular disease risk, which incorporate kidney and metabolic health factors. The guideline also recommends screening for social factors that affect health, such as food insecurity, housing instability and financial strain, to identify higher-risk individuals.
In addition to lifestyle management, the guideline recommends medications, including GLP-1-based therapies for select individuals with obesity and/or Type 2 diabetes, and SGLT2 inhibitors, to reduce the risk of cardiac events. Metabolic and bariatric surgery is also recommended when appropriate. The guideline emphasizes Life’s Essential 8, which includes regular physical activity, healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar and cholesterol, avoiding tobacco and getting enough sleep.
“These actions reduce the risk of heart disease and also support kidney and metabolic health across the lifespan,” said Fátima Rodriguez, M.D., M.P.H., FAHA, FACC, vice chair of the writing committee and associate professor at Stanford Medicine.
The guideline was developed in collaboration with and endorsed by the American Diabetes Association, the American Diabetes Association Obesity Association, and the American Society of Nephrology.
