The American Heart Association and the American College of Cardiology, along with two other leading medical organizations, have issued the first-ever clinical practice guideline on cardiovascular-kidney-metabolic (CKM) syndrome, an interconnected set of health conditions that significantly increase the risk of multiorgan complications and negative cardiovascular outcomes. The guideline, published today in the American Heart Association’s flagship journal Circulation and in JACC, the flagship journal of the American College of Cardiology, highlights that 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.
The guideline introduces a four-stage system to assess how a person’s kidneys, metabolism, and heart are functioning. Stage 1 includes individuals with overweight/obesity or prediabetes but without other metabolic risk factors, kidney disease, or cardiovascular disease. Stage 2 includes those with one or more metabolic risk factors (such as high blood pressure, abnormal lipids, Type 2 diabetes, or metabolic syndrome) and/or kidney disease, but without cardiovascular disease. Stage 3 encompasses people with subclinical cardiovascular disease and CKM risk factors, or those with very-high-risk chronic kidney disease or high predicted 10-year cardiovascular disease risk. Stage 4 includes individuals with diagnosed cardiovascular disease, such as coronary heart disease, heart failure, stroke, peripheral artery disease, or atrial fibrillation, along with overweight/obesity, other metabolic risk factors, or kidney disease. Higher stages are associated with a greater burden of serious health conditions, including Type 2 diabetes, chronic kidney disease, and a higher risk of cardiovascular disease and mortality.
“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 and director of obesity and cardiometabolic research at Johns Hopkins School of Medicine. “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 to estimate 10- and 30-year risk for cardiovascular disease, incorporating kidney and metabolic health factors for more precise risk estimation. The guideline also recommends screening for social factors that affect health, such as food insecurity, housing instability, and financial strain, to identify individuals at higher risk.
Coordinated interdisciplinary care and healthy lifestyle behaviors are emphasized, including attention to physical activity, nutrition, weight, blood pressure, blood sugar, and cholesterol. In conjunction with lifestyle management, treatment options include medications such as GLP-1-based therapies and SGLT2 inhibitors, and metabolic and bariatric surgery when appropriate. For the first time, GLP-1-based therapies are recommended for select individuals with obesity and/or Type 2 diabetes and other risk factors for cardiovascular disease to reduce the risk of cardiac events.
“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. These are all powerful tools to improve cardiovascular-kidney-metabolic health,” said Fátima Rodriguez, M.D., M.P.H., FAHA, FACC, vice chair of the writing committee and associate professor of cardiovascular medicine at Stanford Medicine. “These actions reduce the risk of heart disease and also support kidney and metabolic health across the lifespan.”
The guideline, developed in collaboration with and endorsed by the American Diabetes Association, the American Diabetes Association Obesity Association, and the American Society of Nephrology, underscores that lifestyle modification can make a meaningful difference. Taking action early can help prevent heart attack, heart failure, stroke, or kidney failure. With nearly 40% of U.S. adults and 21% of children and adolescents having obesity, according to recent statistics from the American Heart Association and the American College of Cardiology, this guideline provides a critical framework for addressing the interconnected health crisis.
