New Guideline Redefines Weight as Key Risk Factor in Cardiovascular-Kidney-Metabolic Syndrome
The first-ever clinical guideline for cardiovascular-kidney-metabolic syndrome, issued by the American Heart Association and American College of Cardiology, reframes excess weight as a primary driver of interconnected heart, kidney, and metabolic conditions, urging earlier prevention-focused conversations and coordinated care.
A groundbreaking new clinical guideline released Tuesday reframes excess weight, particularly abdominal fat, as a central risk factor in the development and progression of cardiovascular-kidney-metabolic syndrome, or CKM syndrome. Published jointly by the American Heart Association and the American College of Cardiology, the guideline aims to increase awareness of how heart disease, kidney disease, diabetes, and obesity are interconnected, and urges healthcare professionals to initiate prevention-focused conversations about weight earlier.
Nearly 9 in 10 U.S. adults have at least one condition within CKM syndrome, which includes high blood pressure, abnormal cholesterol, high blood glucose, reduced kidney function, and excess weight. As obesity rates continue to rise, the guideline emphasizes that weight management is critical to preventing future health problems. “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 Dr. Chiadi E. Ndumele, chair of the writing committee. “What’s most important is how fat tissue affects your metabolic health, including how your body manages blood sugar and how fat is used and stored.”
The guideline replaces the 2013 guideline for managing overweight and obesity. It notes that abdominal fat can cause inflammation, leading to insulin resistance and vascular problems, which can progress to diabetes, kidney disease, and organ damage such as heart failure, kidney failure, or stroke. However, if caught early, the disease process can be stopped or reversed. “Prevention is as important, if not more important, than treatment,” said Dr. Ambar Kulshreshtha, a primary care physician and co-author. The guideline offers strategies for discussing weight in non-judgmental ways, starting with questions like, “Is now a good time for us to address your weight and your health and how they may be affecting each other?”
Excess weight increases heart disease and stroke risk by at least 21% for men and 32% for women, according to the American Heart Association. Each 5-unit increase in BMI is associated with a 41% higher risk of heart failure. The guideline outlines proven strategies including healthy lifestyle practices and medications such as SGLT2 inhibitors, GLP-1 based therapies, and nonsteroidal mineralocorticoid receptor antagonists. “We want people to be more aware that there's a process here, and that if there's intervention earlier, they can dramatically improve their long-term outcomes,” Ndumele said.
The guideline also emphasizes coordinated care, recommending the use of CKM coordinators or navigators to bridge primary care and specialty clinicians. “People with CKM syndrome don’t experience one condition at a time — it often all hits at the same time,” said Dr. Fatima Rodriguez, 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 highlights addressing social barriers to healthy lifestyle and quality healthcare. More information on the CKM Health Initiative launched in 2024 is available on heart.org.