AHA, ACC Release First-Ever Cardiovascular-Kidney-Metabolic Syndrome Guidelines

The American Heart Association (AHA) and American College of Cardiology (ACC), among other organizations, have released the first-ever clinical guidelines for the diagnosis and management of cardiovascular-kidney-metabolic (CKM) syndrome.¹

These new guidelines expand on and fully replace the 2013 Guideline for the Management of Overweight and Obesity in Adults, aiming to provide concrete guidance for patients across the recently established CKM syndrome spectrum. The authors conducted a comprehensive literature search from October 2024 to April 2025, including data from MEDLINE, EMBASE, the Cochrane Library, and the Agency for Healthcare Research Quality, among others.¹

“These guidelines really build upon and reflect the fact that metabolic factors such as obesity and diabetes are closely intertwined with chronic kidney disease and cardiovascular disease, and the fact that this is becoming the predominant form of cardiovascular risk in the population,” Chiadi Ndumele, MD, PhD, the director of obesity and cardiometabolic research, director of the heart failure prevention program, and associate professor of medicine and epidemiology at Johns Hopkins University, told HCPLive in an exclusive interview. “These guidelines equip us to better identify individuals with these challenges, to address the components of CKM syndrome holistically, and to think about what our care model needs to look like to support multi-system care for these patients.”

CKM syndrome is understood to originate as a result of excess or dysfunctional adipose tissue, which leads to inflammation in arteries, the kidney, and the heart, as well as insulin sensitivity. The disease is categorized into 4 separate stages, differentiated by clinical signs and risk factors, such as chronic inflammatory conditions, a family history of diabetes or kidney disease, and increased levels of elevated high-sensitivity C-reactive protein.²

The guideline authors collected 10 of the top takeaways from the document, which include the following:

• CKM syndrome staging is recommended for adolescents and adults to prevent progression, reduce cardiovascular events and loss of kidney function, and to promote regression through lifestyle changes
• The Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) equations are recommended to evaluate risk in patients over 10 and 30 years for atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and total cardiovascular disease
• Metabolic risk factors and kidney function assessments should be conducted routinely among all adults, along with pre-HF, metabolic dysfunction-associated steatotic liver disease (MASLD), and obstructive sleep apnea tests in subsets
• Clinicians should routinely assess social determinants of health that may be linked with CKM syndrome development
• Interdisciplinary care is recommended for patients with overlap among type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease – the clinicians also suggest a point person be included to coordinate efforts and facilitate care implementation
• Treatment for overweight or obesity is recommended to assess risk related to excess adiposity, preventing CKM syndrome progression and promoting regression
• Patients with T2D and cardiovascular disease or at risk of cardiovascular disease should receive cardioprotective antihyperglycemic guideline-directed medical therapy, including SGLT2i, GLP-1 RAs, or both
• Clinicians should assess for CKD through eGFR and UACR to guide the use of kidney-protective agents
• ASCVD management should emphasize CKM syndrome comorbidities like obesity, cardiovascular disease, and kidney function
• CKM syndrome factors should be incorporated into HF care – nonsteroidal MRAs should be considered for those with T2D and CKD to prevent adverse cardiovascular events and loss of kidney function.¹

The guideline authors do note, however, that the document does not contain recommendations for blood pressure management, chronic coronary disease, dyslipidemia, HF, or peripheral artery disease. The document instead suggests that other AHA/ACC guidelines be consulted for these conditions.¹

“These guidelines will be very important for improving awareness among clinicians and among patients, and to start to adopt some of these evidence-based therapies earlier in a way that can really maximize care for individuals and keep us from waiting until the late stages when things are much more challenging to handle,” Ndumele said.

Editors’ Note: Ndumele reports no relevant disclosures.

References

1. Ndumele CE, Rodriguez F, Dixon DL, et al. 2026 AHA/ACC/ADA/ASN guideline for the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic syndrome: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online June 9, 2026. doi:10.1161/cir.0000000000001453

2. Ferdinand KC. An overview of cardiovascular-kidney-metabolic syndrome. Am J Manag Care. 2024;30(10 Suppl):S181-S188. doi:10.37765/ajmc.2024.89670