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 on June 9, 2026, in the journals Circulation and JACC, the guideline provides a comprehensive framework for identifying, preventing, and managing this interconnected set of health conditions that significantly increase the risk of heart disease, kidney failure, and mortality.
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 guideline introduces a four-stage classification system to assess risk and tailor prevention strategies. Stage 1 includes individuals with overweight/obesity or prediabetes; Stage 2 adds metabolic risk factors or kidney disease; Stage 3 involves subclinical cardiovascular disease or very-high-risk chronic kidney disease; and Stage 4 includes diagnosed cardiovascular disease such as coronary heart disease, heart failure, or stroke. Higher stages correlate with greater disease burden and risk.
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 risk estimation. The guideline also emphasizes screening for social determinants of health, such as food insecurity and housing instability, which can elevate CKM syndrome risk. Coordinated interdisciplinary care and healthy lifestyle behaviors—focusing on physical activity, nutrition, weight management, blood pressure, blood sugar, and cholesterol—are central to prevention and management.
For the first time, GLP-1-based therapies are recommended for select individuals with obesity and/or Type 2 diabetes who have additional cardiovascular risk factors, to reduce the risk of cardiac events. SGLT2 inhibitors and metabolic and bariatric surgery are also included as treatment options. "Heart, kidney, and metabolic conditions don’t occur in isolation—they are deeply connected," said Dr. Chiadi E. Ndumele, chair of the guideline writing committee. "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."
The guideline underscores that lifestyle modification can make a meaningful difference. Individuals are encouraged to follow the American Heart Association’s Life’s Essential 8, which includes regular physical activity, heart-healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar, and cholesterol, avoiding tobacco, and getting enough quality sleep. "These actions reduce the risk of heart disease and also support kidney and metabolic health across the lifespan," said Dr. Fátima Rodriguez, vice chair of the writing committee.
With 40% of U.S. adults and 21% of children and adolescents having obesity, the guideline reframes weight as a health risk tied to diabetes, kidney, and heart conditions. The impact on business and technology leaders is significant: employers and health systems may need to adapt to new screening and treatment protocols, potentially influencing insurance coverage, workplace wellness programs, and the adoption of digital health tools for risk assessment. The guideline’s emphasis on early intervention could reduce long-term healthcare costs and improve workforce health outcomes.
