First-Ever Guideline on Cardiovascular-Kidney-Metabolic Syndrome Issued

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 for cardiovascular-kidney-metabolic (CKM) syndrome. Nearly 90% of U.S. adults have at least one CKM risk factor, including excess weight, high blood pressure, abnormal lipids, high blood glucose, or reduced kidney function. The guideline, published in Circulation and JACC, details staging to assess how a person's kidneys, metabolism, and heart are functioning.

There are four stages of CKM syndrome. Stage 1 includes individuals with overweight/obesity or prediabetes but no other risk factors. Stage 2 includes those with metabolic risk factors like high blood pressure or Type 2 diabetes and/or kidney disease. Stage 3 involves subclinical cardiovascular disease or very-high-risk chronic kidney disease. Stage 4 is diagnosed cardiovascular disease with CKM risk factors.

The guideline recommends using the PREVENT equations to estimate 10- and 30-year cardiovascular risk, incorporating kidney and metabolic factors. Screening for social determinants of health, such as food insecurity and housing instability, is also advised. Coordinated interdisciplinary care and healthy lifestyle behaviors are emphasized, along with medications including GLP-1-based therapies and SGLT2 inhibitors, and metabolic and bariatric surgery when appropriate.

“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.”

The guideline underscores lifestyle modification, following the American Heart Association’s Life’s Essential 8, which includes regular physical activity, heart-healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar and cholesterol, avoiding tobacco, and getting enough sleep. These actions reduce heart disease risk and support kidney and metabolic health.

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. This comprehensive approach aims to prevent, manage, and potentially reverse CKM syndrome progression.