First Guideline for Cardiovascular-Kidney-Metabolic Syndrome Reframes Weight as Key Health Risk

The first-ever clinical guideline for cardiovascular-kidney-metabolic syndrome, or CKM syndrome, identifies excess weight, especially in the abdomen, as a key driver for the syndrome. Published today by the American Heart Association and the American College of Cardiology, the guideline aims to make people more aware of how heart disease, kidney disease and metabolic conditions—including diabetes and obesity—are interconnected. Nearly 9 in 10 adults in the U.S. have at least one of the conditions within CKM syndrome, which includes high blood pressure, abnormal cholesterol and other lipids, high blood glucose, reduced kidney function and excess weight.

As obesity rates continue to rise, the guideline underscores supporting a healthy weight and calls on healthcare professionals to begin prevention-focused conversations with their patients about how managing weight now can help prevent 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 Chiadi E. Ndumele, M.D., Ph.D., an American Heart Association volunteer and chair of the writing committee for the new guideline, which is jointly issued by the American Heart Association and the American College of Cardiology. “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.”

The CKM syndrome guideline replaces the 2013 guideline for managing overweight and obesity issued by the Heart Association and other societies. CKM syndrome first was defined by the American Heart Association in 2023. “CKM syndrome is a real, rising public health threat,” said Ndumele, who is director of obesity and cardiometabolic research at Johns Hopkins University in Baltimore. He noted that while many people may have been told they have heart disease or kidney disease or diabetes, they may not know how closely all of these conditions are connected. Having one increases the risk of having others, a common challenge in CKM syndrome. Having obesity also raises that risk.

The guideline gives healthcare professionals a reason for discussing weight—not as a cosmetic issue, but as a risk factor that can lead to organ damage. “We are saying that prevention is as important, if not more important, than treatment,” said Ambar Kulshreshtha, M.D., Ph.D., a volunteer member of the Heart Association’s Council on Quality of Care and Outcomes Research and a primary care physician who also helped write the new guideline. In medical terms, the problem with having overweight or obesity is when fat tissue accumulates in the belly and clings to organs in the abdomen. Such fat can cause inflammation, which leads to insulin resistance and problems with the way blood vessels dilate and contract. As these issues persist, CKM syndrome progresses to include diabetes, kidney disease and eventually organ damage that may include kidney failure, heart failure, liver disease, heart attacks or strokes. If caught early, however, the disease process in CKM syndrome can be stopped or even reversed.

When explaining CKM syndrome to his own patients, Kulshreshtha likens the body’s blood vessels to plumbing in a house. Obesity causes inflammation, which he compares to rust. “The rust can damage the pipes, which is like your vascular system,” he said. “It can damage the pump, which is like your heart. And it can damage the filters, like your kidneys.” Ndumele said the guideline offers ways for healthcare professionals to discuss weight in non-judgmental ways. “It starts with a question of, ‘Is now a good time for us to address your weight and your health and how they may be affecting each other?’” The idea is to stop hard-to-treat problems before they start.

The guideline includes proven strategies to support healthy lifestyle practices as the foundation of CKM syndrome management. It also outlines the use of increasingly effective medications that benefit multiple body systems, including SGLT2 inhibitors, GLP-1 based therapies and nonsteroidal mineralocorticoid receptor antagonists. “We want people in the community to be more aware of the fact that, ‘Hey, there's a process here,’ and that if there's intervention earlier, ‘I can dramatically improve my long-term outcomes,’” Ndumele said.

In addition to changing how clinicians talk to patients about weight, the guideline offers general principles to improve the way healthcare professionals work together to address obesity, diabetes, chronic kidney disease and heart disease. “We, as either primary care clinicians or sub-specialists, operate from our own silos,” said Fatima Rodriguez, M.D., M.P.H., vice-chair of the guideline writing committee and chief of preventive cardiology at Stanford University. “But people with CKM syndrome don’t experience one condition at a time—it often all hits at the same time.” The guideline outlines the benefits of using CKM coordinators, or navigators, to coordinate care between the different healthcare professionals and patients, and to ensure follow-up care. As part of whole-person care, the guideline also emphasizes identifying social barriers to healthy lifestyle and quality healthcare, and providing social support as needed.

In 2024, the American Heart Association launched the CKM Health Initiative to provide a path forward for patients, communities and healthcare professionals to improve diagnosis and treatment for CKM syndrome. Learn more about it on the initiative’s page at heart.org. The Association receives more than 85% of its revenue from sources other than corporations. Overall financial information is available here.