The American Heart Association and American College of Cardiology, along with two other leading medical organizations, have developed the first guidelines for the prevention and management of cardiovascular, renal, and metabolic syndrome (CKM). CKM is a set of interrelated health conditions that significantly increase the risk of multisystem complications and negative cardiovascular outcomes. Almost 90% of U.S. adults have at least one risk factor for CKM syndrome, including excess weight, high blood pressure, abnormal lipids, high blood sugar (sugar), and decreased kidney function.
Recommendations to help clinicians and individuals identify risk for CKM syndrome early and take steps to protect long-term cardiac, metabolic, and renal health are detailed in this new clinical practice guideline, published today in the American Heart Association’s flagship peer-reviewed journal. circulation And then jackthe flagship journal of the American College of Cardiology.
According to recent statistics from the American Heart Association and American College of Cardiology, 40 percent of U.S. adults and 21 percent of U.S. children and adolescents have obesity, defined as excess body fat that poses a risk to health. Obesity is a risk factor for hypertension, type 2 diabetes, metabolic dysfunction, cardiovascular disease, and kidney disease.
Heart, kidney, and metabolic conditions do not occur in isolation; they are deeply interconnected. The guidelines call for early screening and care, with an emphasis on prevention and coordinated actions to reduce the risk of cardiovascular disease, before serious complications develop or serious cardiac events occur. ”
Chiadi E. Ndumele, MD, Ph.D., MHS, FAHA, Chair of the Guideline Development Committee and Director of Obesity and Cardiometabolic Research, Johns Hopkins School of Medicine, Baltimore
What are the stages of cardiovascular-renal-metabolic syndrome (CKM)?
There are four stages of CKM syndrome. During these stages, risks are identified and prevention strategies are tailored to slow or reverse the progression of CKM syndrome.
- Stage 1: People who are overweight/obese or have prediabetes but no other metabolic risk factors, kidney disease, or cardiovascular disease
- Stage 2: Includes people with one or more metabolic risk factors (such as high blood pressure, abnormal lipid levels, type 2 diabetes, metabolic syndrome) and/or kidney disease but no cardiovascular disease.
- Stage 3: People with asymptomatic (asymptomatic) cardiovascular disease and CKM risk factors. or patients at a predicted risk of very high risk chronic kidney disease or high 10-year risk of cardiovascular disease (based on the PREVENT-CVD equation)
- Stage 4: People diagnosed with cardiovascular disease (coronary heart disease, heart failure, stroke, peripheral artery disease and/or atrial fibrillation) with overweight or obesity, other metabolic risk factors or kidney disease
Key highlights of the guidelines include:
- Improve risk assessment using the Cardiovascular Disease Risk Prediction Event (PREVENT) equation to estimate 10-year and 30-year cardiovascular disease risk. This helps guide your individualized lifestyle and treatment plan. PREVENT incorporates renal and metabolic health factors into the equation for a more comprehensive and accurate risk estimation compared to previous tools.
- Screening for social factors that influence health, such as food insecurity, housing instability, and financial strain, is also recommended to identify individuals at increased risk of developing CKM syndrome.
- Prevention and management of CKM syndrome emphasizes multidisciplinary care and adjustment of healthy lifestyle behaviors, including attention to physical activity, nutrition, weight, blood pressure, blood sugar, and cholesterol.
- Along with lifestyle management, additional treatment options for CKM syndrome include medications such as medications to manage blood pressure, cholesterol, blood sugar levels, weight, and protect the heart and kidneys, as well as surgical treatments. GLP-1-based therapy is recommended for the first time for selected individuals with obesity and/or type 2 diabetes and other risk factors for cardiovascular disease to reduce the risk of cardiac events. Metabolic and bariatric surgery may also be used to treat CKM syndrome.
What should people do to prevent CKM syndrome?
The guidelines emphasize that lifestyle modifications can make a big difference to your overall health. By taking action early, you can prevent heart attack, heart failure, stroke, and kidney failure. Individuals are encouraged to follow the American Heart Association’s Life’s Essential 8 recommendations for improving and maintaining cardiovascular health.
Life’s Essential 8 focuses on regular physical activity, a heart-healthy diet, maintaining a healthy weight, managing blood pressure, blood sugar, and cholesterol, as well as avoiding tobacco and getting plenty of quality sleep. These are all powerful tools for improving cardiovascular, renal, and metabolic health. These actions reduce the risk of heart disease and support kidney and metabolic health throughout life. ”
Fatima Rodriguez, MD, MPH, FAHA, FACC, Vice Chair of the Writing Committee, Associate Professor of Cardiovascular Medicine at Stanford Medicine (Stanford, CA)
This guideline was approved and developed by the Joint Committee on Clinical Practice Guidelines of the American Heart Association and American College of Cardiology, in collaboration with the American Diabetes Association. American Diabetes Association Obesity Association. and the American Society of Nephrology.
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Reference magazines:
Ndumere, C.E.; Others. (2026). 2026 AHA/ACC/ADA/ASN Guidelines for the Prevention, Detection, Evaluation, and Management of Cardiovascular, Renal, and Metabolic Syndromes: Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. circulation. DOI: 10.1161/CIR.0000000000001453. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001453
