The first guideline for cardiovascular-kidney-metabolic syndrome details staging, screening, risk assessment, and treatment.
The American Heart Association and American College of Cardiology have issued the first clinical practice guideline for
The guideline, published in Circulation and JACC, defines CKM syndrome as an interconnected set of cardiovascular, kidney, and metabolic conditions that increase the risk of multiorgan complications and adverse cardiovascular outcomes.1
Nearly
The document was led by the AHA and ACC Joint Committee on Clinical Practice Guidelines and developed in collaboration with and endorsed by the American Diabetes Association, the American Diabetes Association Obesity Association, and the American Society of Nephrology.
“Heart, kidney, and metabolic conditions don’t occur in isolation—they are deeply connected,” Chiadi E. Ndumele, MD, PhD, MHS, chair of the guideline writing committee and director of obesity and cardiometabolic research at Johns Hopkins School of Medicine, said in an AHA press release.3 “This guideline calls for earlier screening and care, focusing on prevention and coordinated action to reduce the risk of
Key Facts
The guideline uses 4 stages to identify
Stage 3 includes individuals with subclinical cardiovascular disease and CKM risk factors or risk equivalents such as very-high-risk chronic kidney disease or high predicted 10-year cardiovascular disease risk based on PREVENT-CVD equations. Stage 4 includes individuals with diagnosed cardiovascular disease, including coronary heart disease, heart failure, stroke, peripheral artery disease, and/or atrial fibrillation, plus overweight or obesity, other metabolic risk factors, or kidney disease.1
Key recommendations include use of the Predicting Risk of cardiovascular disease EVENTs, or PREVENT, equations to estimate 10- and 30-year cardiovascular disease risk. The guideline also recommends screening for social factors that affect health, including food insecurity, housing instability, and financial strain.1
Management emphasizes coordinated interdisciplinary care and lifestyle behaviors, including physical activity, nutrition, weight management, blood pressure control, glycemic management, lipid management, tobacco avoidance, and healthy sleep. The guideline also includes medications and surgical therapies to manage blood pressure, cholesterol, blood glucose, weight, and cardiorenal risk.1
For the first time, GLP-1–based therapies are recommended for select individuals with obesity and/or type 2 diabetes and other cardiovascular risk factors to reduce the risk of cardiac events. SGLT2 inhibitors and metabolic and bariatric surgery also are included as appropriate treatment options for selected patients.1
“The CKM syndrome care model reflects a paradigm shift to less-siloed, more integrated clinical care for those with multiple interconnected clinical conditions. It will be important to reconsider how education and training need to adapt to reflect this shift in clinical approach,” investigators concluded.1
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