The first-ever clinical guideline for cardiovascular-kidney-metabolic syndrome (CKM syndrome), published today by the American Heart Association and the American College of Cardiology, reframes excess weight, especially abdominal fat, as a central risk factor for a cluster of interconnected conditions including heart disease, kidney disease, diabetes, and obesity. The guideline aims to shift clinical practice toward earlier, prevention-focused conversations about weight and metabolic health, emphasizing that managing weight can prevent future organ damage.
Nearly 9 in 10 adults in the U.S. have at least one component of CKM syndrome, such as high blood pressure, abnormal cholesterol, high blood sugar, reduced kidney function, or excess weight. As obesity rates continue to climb, the guideline underscores the importance of addressing weight not as a cosmetic issue but as a key driver of metabolic dysfunction that can lead to inflammation, insulin resistance, and vascular problems. "In terms of CKM health, weight is not just about a number on a scale — people with the same body weight can have very different health profiles," said Dr. Chiadi E. Ndumele, chair of the writing committee. "Rather, what’s most important is how fat tissue affects your metabolic health."
The guideline replaces the 2013 obesity management guideline and builds on the American Heart Association’s 2023 definition of CKM syndrome. It provides healthcare professionals with a framework to discuss weight in non-judgmental ways and to use tools such as body mass index (BMI) and waist circumference to assess risk. Excess weight increases heart disease and stroke risk by at least 21% in men and 32% in women, and each 5-unit increase in BMI is associated with a 41% higher risk of heart failure.
To improve care coordination, the guideline recommends using navigators or care coordinators to bridge communication between primary care and specialty clinicians. "We, as either primary care clinicians or sub-specialists, operate from our own silos," said Dr. Fatima Rodriguez, vice-chair of the writing committee. "But people with CKM syndrome don’t experience one condition at a time — it often all hits at the same time." The guideline also highlights the use of effective medications such as SGLT2 inhibitors, GLP-1 based therapies, and nonsteroidal mineralocorticoid receptor antagonists that benefit multiple body systems.
Dr. Ambar Kulshreshtha, a primary care physician and guideline co-author, emphasized that prevention is paramount. "We are saying that prevention is as important, if not more important, than treatment." The guideline provides strategies to support healthy lifestyle practices and early intervention, with the goal of stopping or even reversing CKM syndrome in its early stages. For more information, visit the American Heart Association's CKM Health Initiative page.
