The American Heart Association and the American College of Cardiology, along with two other leading medical organizations, have developed the first-ever clinical practice guideline aimed at preventing and managing cardiovascular-kidney-metabolic (CKM) syndrome. Published today in Circulation and JACC, the guideline details a staging system to assess how a person's kidneys, metabolism, and heart are functioning, with higher stages associated with a greater burden of serious health conditions such as Type 2 diabetes, chronic kidney disease, and increased risk of cardiovascular disease and mortality.
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. The guideline emphasizes that heart, kidney, and metabolic conditions are deeply connected and calls for earlier screening and coordinated action to reduce the risk of cardiovascular disease before serious complications develop. “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,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, chair of the guideline writing committee.
The staging system identifies four stages of CKM syndrome: Stage 1 includes individuals with overweight/obesity or prediabetes; Stage 2 includes those with metabolic risk factors or kidney disease; Stage 3 involves subclinical cardiovascular disease or very-high-risk chronic kidney disease; and Stage 4 includes individuals with diagnosed cardiovascular disease and metabolic risk factors or kidney disease. This staging helps tailor prevention strategies to slow or reverse progression.
Key highlights from the guideline include improved risk assessment using the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations, which estimate 10- and 30-year risk for cardiovascular disease and incorporate kidney and metabolic health factors for more precise risk estimation. Screening for social factors such as food insecurity, housing instability, and financial strain is also recommended to identify individuals at higher risk. Coordinated interdisciplinary care and healthy lifestyle behaviors, including attention to physical activity, nutrition, weight, blood pressure, blood sugar, and cholesterol, are emphasized.
For the first time, GLP-1-based therapies are recommended for select individuals with obesity and/or Type 2 diabetes and other risk factors for cardiovascular disease to reduce the risk of cardiac events. Medications such as SGLT2 inhibitors and metabolic and bariatric surgery are also recommended when appropriate. The guideline underscores that lifestyle modification can make a meaningful difference, and individuals are encouraged to follow the American Heart Association's Life's Essential 8, which focuses on regular physical activity, heart-healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar, and cholesterol, avoiding tobacco, and getting enough quality sleep.
“Life's Essential 8 focuses on regular physical activity, heart-healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar and cholesterol, as well as avoiding tobacco and getting enough quality sleep. These are all powerful tools to improve cardiovascular-kidney-metabolic health,” said Fátima Rodriguez, M.D., M.P.H., FAHA, FACC, vice chair of the writing committee. 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. More information can be found at heart.org and ACC.org.
