First U.S. Guideline Released for Cardiovascular-Kidney-Metabolic (CKM) Syndrome
USA: The first dedicated U.S. guideline by the American College of Cardiology/American Heart Association provides comprehensive recommendations for the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic (CKM) syndrome.
CKM syndrome is a systemic health condition that reflects the interconnected relationship between heart disease, kidney disease, diabetes, and obesity.
The guideline emphasizes early identification, coordinated care between primary care physicians and specialists, and aggressive risk-factor management.
Healthy lifestyle changes and weight management are strongly recommended for all patients, while medications such as GLP-1 receptor agonists and other evidence-based therapies are advised early in the disease course when appropriate.
The guidance aims to improve outcomes by integrating cardiovascular, renal, and metabolic care, recognizing that these conditions often coexist and accelerate one another's progression.
Published in the Journal of the American College of Cardiology (JACC), the 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome was developed by Chiadi E. Ndumele and colleagues on behalf of the American Heart Association, American College of Cardiology, American Diabetes Association, and American Society of Nephrology.
The guideline replaces and expands upon previous obesity management recommendations and introduces a comprehensive framework for clinicians managing patients with overlapping cardiovascular, kidney, and metabolic disorders. It is intended for cardiologists, endocrinologists, nephrologists, primary care physicians, and other healthcare professionals involved in CKM care.
A central feature of the guideline is a new CKM syndrome staging system designed to identify risk early and guide treatment intensity throughout a patient's life course. Under this framework, Stage 0 includes individuals without CKM components, while Stage 1 is characterized by excess or dysfunctional adipose tissue. Stage 2 includes metabolic risk factors such as hypertension, hypertriglyceridemia, metabolic syndrome, type 2 diabetes, chronic kidney disease, or combinations of these conditions. Stage 3 includes patients with subclinical cardiovascular disease, very high-risk chronic kidney disease, or a predicted 10-year cardiovascular risk of at least 20%. Stage 4 represents established clinical cardiovascular disease.
Key Takeaways
- A new CKM staging system is recommended for both adults and youths to guide prevention, treatment, and disease regression.
- The PREVENT risk equations should be used to estimate 10-year and 30-year risks of atherosclerotic cardiovascular disease, heart failure, and overall cardiovascular disease.
- Routine screening for metabolic risk factors and kidney function is recommended in adults.
- Assessment of social determinants of health should be incorporated into CKM care.
- Interdisciplinary care models with a designated care coordinator are encouraged for patients with overlapping cardiovascular, kidney, and metabolic conditions.
- Body mass index and waist circumference should be routinely assessed to identify obesity-related risk.
- Lifestyle modification remains the foundation of therapy, with anti-obesity medications and bariatric surgery considered when appropriate.
- Patients with type 2 diabetes and cardiovascular risk should receive cardioprotective therapies such as SGLT2 inhibitors, GLP-1–based therapies, or both.
- Kidney function assessment should include estimated glomerular filtration rate and urine albumin-to-creatinine ratio to guide treatment decisions.
- CKM risk factors should be actively addressed in patients with atherosclerotic cardiovascular disease and heart failure to improve both cardiovascular and renal outcomes.
The guideline places strong emphasis on prevention and early intervention. Regular assessment of kidney function, metabolic abnormalities, obesity, and cardiovascular risk factors is recommended to identify patients before progression to advanced disease stages. The authors also highlight the importance of addressing social determinants of health, recognizing that factors such as healthcare access, education, income, and living conditions substantially influence CKM outcomes.
For patients with type 2 diabetes, the guideline recommends the early use of therapies proven to provide cardiovascular and kidney protection. These include sodium-glucose cotransporter-2 (SGLT2) inhibitors and GLP-1–based therapies, with treatment selection guided by coexisting conditions such as chronic kidney disease, atherosclerotic cardiovascular disease, heart failure, obesity, and metabolic dysfunction–associated steatotic liver disease.
The recommendations also provide detailed guidance for managing CKM syndrome in patients with established cardiovascular disease and heart failure. In addition to standard cardiovascular therapies, clinicians are encouraged to address obesity, diabetes, and kidney disease simultaneously to reduce cardiovascular events, slow kidney function decline, and improve overall outcomes.
The writing committee concluded that CKM syndrome should be viewed as a single interconnected condition rather than separate diseases treated in isolation. By promoting risk-based staging, coordinated multidisciplinary care, and early implementation of evidence-based therapies, the guideline seeks to reduce the growing burden of cardiovascular disease, chronic kidney disease, diabetes, and obesity worldwide.
Reference:
Ndumele CE, Rodriguez F, Dixon DL, Khan SS, Mukherjee D, Bajaj M, Bangalore S, Bozkurt B, Breathett K, Clarke SL, de Boer IH, Ellison DH, Evangelista LS, Heffron SP, Kazi DS, Kulshreshtha A, Lingvay I, Low Wang CC, Mercado CA, Morton JM, Neeland IJ, Pagidipati N, Powell-Wiley TM, Rangaswami J, Rao G, Reza N, Saeed A, St. Peter W, Starks JB, Sterling M, Talbot AW, Tran AH, Tuttle KR, VanWagner LB, Vest AR, Virani SS. 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. J Am Coll Cardiol. 2026;87(22S):e1889–e2007.
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