The American Heart Association and the American College of Cardiology, in collaboration with the American Diabetes Association and the American Society of Nephrology, have issued the first-ever clinical practice guideline for cardiovascular-kidney-metabolic (CKM) syndrome. Published simultaneously in Circulation and the Journal of the American College of Cardiology, the guideline provides a framework for staging, screening, and managing this interconnected set of health conditions that significantly increase the risk of multiorgan complications and negative cardiovascular outcomes.
According to the guideline, 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 syndrome comprises four stages, from Stage 1 (overweight/obesity or prediabetes without other risk factors) to Stage 4 (diagnosed cardiovascular disease with metabolic risk factors or kidney disease). Higher stages are associated with greater burden of serious conditions such as Type 2 diabetes, chronic kidney disease, and increased 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, which incorporate kidney and metabolic health factors for more precise estimation of 10- and 30-year cardiovascular risk. The guideline also emphasizes screening for social factors such as food insecurity, housing instability, and financial strain, which can identify individuals at higher risk.
Coordinated interdisciplinary care and healthy lifestyle behaviors—including physical activity, nutrition, weight management, blood pressure control, and blood sugar and cholesterol management—are central to prevention and management. For the first time, the guideline recommends GLP-1-based therapies for select individuals with obesity and/or Type 2 diabetes and other cardiovascular risk factors to reduce cardiac events. Metabolic and bariatric surgery may also be used when appropriate.
“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,” 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, endorsed by the American Diabetes Association and the American Society of Nephrology, underscores that lifestyle modification can make a meaningful difference. With obesity affecting 40% of U.S. adults and 21% of children and adolescents, according to statistics from the American Heart Association and the American College of Cardiology, the new recommendations aim to help clinicians and individuals identify risk earlier and take action to protect long-term health.
