AHA, ACC Issue First-Ever Clinical Guideline for Cardiovascular-Kidney-Metabolic Syndrome

The American Heart Association and the American College of Cardiology jointly issued the first-ever clinical guideline for cardiovascular-kidney-metabolic (CKM) syndrome, identifying excess weight, particularly in the abdomen, as a key driver for the syndrome's development and progress.

In the United States, nearly 90% of adults have ≥ 1 risk factor of CKM syndrome, including excess weight, high blood pressure, abnormal lipids, high blood glucose, or reduced kidney function. As obesity rates continue to ascend, the guideline encourages clinicians to have preventive conversations with their patients about risk factors, acknowledging that taking early action has the potential to help prevent a heart attack, heart failure, stroke, or kidney failure.

"Heart, kidney, and metabolic conditions don't occur in isolation — they are deeply connected," said Chiadi E. Ndumele, MD, PhD, 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."

CKM syndrome was first defined by the American Heart Association in 2023, meaning historically, diabetes, kidney disease, and heart conditions have been treated as separate problems by individual specialties. These guidelines mark an attempt to close a gap in treatment care.

How Clinicians Should Screen and Assess CKM Syndrome Risk

The guideline introduces a 4-stage framework to stratify risk, guide intervention timing, and is designed to move clinical attention upstream. Progression may be slowed or reversed, particularly at earlier stages, underscoring the case for screening before organ damage occurs.

The guidelines include improved risk assessment using the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to estimate 10- and 30-year risk for cardiovascular disease, which can help guide individualized lifestyle and treatment plans. PREVENT includes kidney and metabolic health factors in the equations for a more comprehensive and precise estimation of risk compared with previous tools.

Screening for social factors that affect health, including food insecurity, housing instability and financial strain, is also recommended to identify individuals at higher risk of developing CKM syndrome.

What the CKM Syndrome Guideline Recommends for Treatment

Coordinated interdisciplinary care and healthy lifestyle behaviors, including attention to physical activity, nutrition, weight, blood pressure, blood sugar and cholesterol, are emphasized to prevent and manage CKM syndrome.

Along with lifestyle changes, additional treatment options for CKM syndrome include medications and surgical therapies, such as medications to manage blood pressure, cholesterol, blood sugar and weight, to protect the heart and kidneys.

This marks the first time that 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. Additionally, metabolic and bariatric surgery may also be used to treat CKM syndrome.

References

1. Ndumele CE, et al. 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome. Circulation. 2026. doi:10.1161/CIR.0000000000001453

2. American Heart Association. First-ever guideline on cardiovascular-kidney-metabolic syndrome issued. EurekAlert! June 9, 2026. https://www.eurekalert.org/news-releases/1130966

3. American Heart Association. New guideline reframes weight as health risk tied to diabetes, kidney and heart conditions. EurekAlert! June 9, 2026. https://www.eurekalert.org/news-releases/1130970