The American Heart Association and the American College of Cardiology have issued the first-ever clinical guideline for cardiovascular-kidney-metabolic (CKM) syndrome, a condition that affects nearly 9 in 10 adults in the U.S. The guideline, published on June 9, 2026, reframes weight not merely as a cosmetic issue but as a critical health risk tied to diabetes, kidney disease, and heart conditions. It emphasizes that excess weight, particularly abdominal fat, is a key driver of CKM syndrome and calls on healthcare professionals to initiate prevention-focused conversations about weight management early.
“In terms of CKM health, weight is not just about a number on a scale — people with the same body weight can have very different health profiles,” said Chiadi E. Ndumele, M.D., Ph.D., chair of the writing committee. “Rather, what’s most important is how fat tissue affects your metabolic health. This includes how your body manages blood sugar levels and how fat is used and stored.”
CKM syndrome, first defined by the American Heart Association in 2023, encompasses the interplay between cardiovascular disease, chronic kidney disease, and metabolic conditions such as obesity and diabetes. The new guideline replaces the 2013 guideline for managing overweight and obesity and provides a unified framework for clinicians to address these interconnected conditions.
“CKM syndrome is a real, rising public health threat,” Ndumele said. He noted that while patients may have been told they have heart disease, kidney disease, or diabetes separately, they may not realize how closely these conditions are linked. Having one condition increases the risk of developing others, and obesity further elevates that risk. The guideline aims to help clinicians from various specialties “speak in a common language and be on the same page, especially when it comes to managing weight and its clinical consequences.”
The problem with overweight or obesity, medically, is the accumulation of fat tissue in the abdomen that clings to organs. This fat can cause inflammation, leading to insulin resistance and problems with blood vessel function. As these issues persist, CKM syndrome progresses to include diabetes, kidney disease, and eventually organ damage such as kidney failure, heart failure, liver disease, heart attacks, or strokes. However, if caught early, the disease process can be stopped or even reversed.
“We are saying that prevention is as important, if not more important, than treatment,” said Ambar Kulshreshtha, M.D., Ph.D., a primary care physician who helped write the guideline. He likens obesity-related inflammation to rust in a house’s plumbing: “The rust can damage the pipes, which is like your vascular system. It can damage the pump, which is like your heart. And it can damage the filters, like your kidneys.”
The guideline offers non-judgmental ways for healthcare professionals to discuss weight, starting with a question like, “Is now a good time for us to address your weight and your health and how they may be affecting each other?” It also outlines proven strategies, including lifestyle practices and increasingly effective medications such as SGLT2 inhibitors, GLP-1 based therapies, and nonsteroidal mineralocorticoid receptor antagonists, which benefit multiple body systems.
Excess weight increases the risk of heart disease and stroke by at least 21% for men and 32% for women, according to the American Heart Association. Each 5-unit increase in body mass index (BMI) is associated with a 41% higher risk of heart failure. The guideline stresses that early conversations and tools can prevent dangerous stages or reverse early CKM syndrome.
Coordinating care is another key focus. The guideline recommends using CKM coordinators or navigators to improve communication between primary care and specialty clinicians and to ensure follow-up care. “People appreciate being seen and treated holistically,” said Fatima Rodriguez, M.D., M.P.H., vice-chair of the writing committee. “The idea is that patient care is a team effort, and the patient is team captain.”
The guideline also emphasizes identifying social barriers to healthy lifestyle and quality healthcare. In 2024, the American Heart Association launched the CKM Health Initiative to improve diagnosis and treatment. More information is available on the initiative’s page at heart.org.
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