AHA, ACC, ADA and ASN issue first joint guideline on cardiovascular-kidney-metabolic syndrome

The American Heart Association (AHA), American College of Cardiology (ACC), American Diabetes Association (ADA) and American Society of Nephrology (ASN) have issued a new joint clinical practice guideline for the prevention, detection, evaluation and management of cardiovascular-kidney-metabolic (CKM) syndrome.

Published in Circulation on June 9, 2026, the guideline sets out an integrated framework for identifying and managing overlapping cardiovascular, kidney and metabolic risk. It brings obesity, type 2 diabetes, chronic kidney disease (CKD) and cardiovascular disease into a single prevention pathway, with the aim of supporting earlier intervention before overt cardiovascular disease develops.¹

CKM syndrome describes the overlapping pathways linking excess adiposity, impaired glucose metabolism, chronic kidney disease (CKD) and cardiovascular disease. Nearly 90% of US adults have at least one CKM risk factor, including excess weight, high blood pressure, abnormal lipids, high blood glucose or reduced kidney function, while approximately 40% of US adults have obesity.²

The guideline addresses a common challenge in clinical practice: patients with obesity, type 2 diabetes, CKD and cardiovascular disease are often managed through separate care pathways, despite shared mechanisms and overlapping risk. Excess weight is a key driver of CKM progression; according to the American Heart Association, it is associated with at least a 21% increased risk of cardiovascular disease and stroke in men and at least a 32% increased risk in women, while each 5-unit increase in body mass index is associated with a 41% higher risk of heart failure.²

What does the guideline recommend?

The guideline introduces a stage-based CKM framework to help clinicians recognize risk earlier and tailor prevention and treatment strategies. Stage 0 describes people without CKM risk factors. Stage 1 includes people with overweight, obesity or prediabetes, but without other metabolic risk factors, CKD or cardiovascular disease. Stage 2 includes people with metabolic risk factors, such as high blood pressure, abnormal lipid levels, type 2 diabetes or metabolic syndrome, and/or CKD, but without cardiovascular disease. Stage 3 includes people with subclinical cardiovascular disease and CKM risk factors, or those with CKM risk equivalents such as very-high-risk CKD or high predicted 10-year cardiovascular risk. Stage 4 includes people with diagnosed cardiovascular disease alongside CKM risk factors.

The PREVENT tool is positioned as the preferred approach for estimating both near-term and longer-term cardiovascular risk in people with CKM syndrome stages 0–3. This includes estimation of 10- and 30-year risk for atherosclerotic cardiovascular disease, heart failure and total cardiovascular disease. A predicted 10-year cardiovascular disease risk of 20% or higher is one criterion for Stage 3 CKM syndrome, while a predicted risk of 7.5% or higher may help guide prioritization of pharmacological treatment.

What are the key treatment recommendations?

In practical terms, the guideline brings cardiometabolic and kidney-protective therapies into a single prevention framework. For patients with type 2 diabetes, CKD or elevated cardiovascular risk, treatment selection should consider therapies with evidence across more than one CKM domain, including sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1-based therapies, renin-angiotensin system inhibitors and, in selected patients with persistent albuminuria, nonsteroidal mineralocorticoid receptor antagonists.

Lifestyle modification and weight management remain central to CKM prevention and management. The guideline also supports regular checks for blood pressure, lipid levels, glucose status and kidney health, as well as targeted evaluation for conditions that commonly cluster with CKM syndrome, including early heart failure, metabolic dysfunction-associated steatotic liver disease and obstructive sleep apnea, where clinically appropriate.

The document also places social barriers to care at the center of long-term risk reduction. Clinicians are encouraged to consider factors such as food insecurity, housing instability and financial strain, which may affect CKM risk, treatment access and adherence.

Why is this relevant for cardiologists?

The guideline reframes cardiovascular prevention as a shared cardiovascular, renal and metabolic responsibility. For cardiologists, the practical shift is earlier recognition of patients at risk before overt cardiovascular disease develops, particularly those with obesity, type 2 diabetes, CKD or evidence of subclinical cardiovascular disease.

The stage-based framework may help clinicians identify which patients need intensified risk assessment, closer follow-up or coordinated input from nephrology, endocrinology, primary care, pharmacy or weight management services. The use of PREVENT also gives clinicians a more CKM-specific approach to long-term risk estimation than traditional cardiovascular risk calculators.

Limitations and implementation considerations

As a clinical practice guideline, the recommendations reflect the available evidence base, which varies across CKM stages, patient groups and therapies. Implementation may also be challenging in settings without established multidisciplinary pathways, care coordinators or easy access to obesity pharmacotherapy, kidney-protective therapies and social support services.

The guideline is based largely on US evidence, epidemiology and healthcare infrastructure, so adaptation may be required in other healthcare systems. Practical issues such as medication access, cost, long-term adherence and equitable implementation will be important as CKM care pathways develop.

Clinical takeaway

The new CKM syndrome guideline gives cardiologists and related specialists a structured framework for recognizing cardiovascular, kidney and metabolic risk earlier in the disease course. Its main value is not a single new treatment recommendation, but a clearer clinical pathway for managing overlapping risk before cardiovascular disease becomes established.

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. American Heart Association. New guideline reframes weight as health risk tied to diabetes, kidney and heart conditions. News release. June 9, 2026. Accessed June 11, 2026. https://newsroom.heart.org/news/new-guideline-reframes-weight-as-health-risk-tied-to-diabetes-kidney-and-heart-conditions