First-Ever Guideline on Cardiovascular-Kidney-Metabolic Syndrome Issued
The American Heart Association and the American College of Cardiology released the first clinical practice guideline on cardiovascular-kidney-metabolic (CKM) syndrome, emphasizing early screening and coordinated care to address interconnected heart, kidney, and metabolic conditions affecting nearly 90% of U.S. adults.
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 greater risk of Type 2 diabetes, chronic kidney disease, 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. According to recent statistics from the American Heart Association and the American College of Cardiology, 40% of U.S. adults and 21% of children and adolescents have obesity, a key driver of CKM syndrome.
The guideline introduces four stages of CKM syndrome. Stage 1 includes individuals with overweight/obesity or prediabetes but no other metabolic risk factors, kidney disease or cardiovascular disease. Stage 2 adds one or more metabolic risk factors such as high blood pressure, abnormal lipids, Type 2 diabetes or metabolic syndrome, and/or kidney disease. Stage 3 involves subclinical cardiovascular disease or very-high-risk chronic kidney disease. Stage 4 includes diagnosed cardiovascular disease such as coronary heart disease, heart failure, stroke, peripheral artery disease or atrial fibrillation.
“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. “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.”
Key recommendations include improved risk assessment using the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations, which incorporate kidney and metabolic health factors for more precise estimation. The guideline also recommends screening for social factors affecting health, such as food insecurity, housing instability and financial strain. 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 cardiovascular risk factors. SGLT2 inhibitors and metabolic and bariatric surgery are also recommended when appropriate. “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,” said Fátima Rodriguez, M.D., M.P.H., FAHA, FACC, vice chair of the writing committee.
The guideline was developed in collaboration with the American Diabetes Association, the American Diabetes Association Obesity Association, and the American Society of Nephrology. It underscores that lifestyle modification can make a meaningful difference, and taking action early can help prevent heart attack, heart failure, stroke or kidney failure.