New playbook for cardiometabolic care links heart, kidney, and metabolic risks

Clinical Takeaway: Routinely stage patients for cardiovascular-kidney-metabolic (CKM) syndrome, assess both eGFR and urine albumin-to-creatinine ratio, prioritize weight management, and consider SGLT2 inhibitors and GLP-1–based therapies according to CKM stage and cardiovascular risk.

The first-ever AHA/ACC/ADA/ASN guideline for cardiovascular-kidney-metabolic (CKM) syndrome reframes obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease (CVD) as interconnected conditions requiring coordinated, risk-based management. The guideline replaces the 2013 obesity guideline and introduces a CKM staging framework (stages 0-4) to guide prevention, treatment intensity, and long-term monitoring.

A major shift is the recommendation to assess obesity using both BMI and waist circumference and to treat excess adiposity as a primary driver of CKM progression. Lifestyle intervention remains first-line therapy, but the guideline strongly supports adjunctive use of anti-obesity medications and metabolic/bariatric surgery when needed. GLP-1–based therapies are recommended to promote weight loss, improve CKM risk profiles, and, in selected populations, reduce cardiovascular events.

The guideline also emphasizes routine risk assessment using the PREVENT equations to estimate 10- and 30-year risk for ASCVD, heart failure, and total CVD. Adults should undergo regular screening for metabolic risk factors and kidney disease, including both eGFR and urine albumin-to-creatinine ratio, with CKD management focused on early use of renin-angiotensin system inhibitors and SGLT2 inhibitors. For patients with CKD and T2D who have persistent albuminuria, addition of finerenone or a GLP-1–based therapy is recommended to further reduce kidney and cardiovascular risk.

For patients with T2D and elevated cardiovascular risk, the guideline recommends cardioprotective antihyperglycemic therapy with an SGLT2 inhibitor, a GLP-1–based therapy, or both, regardless of glycemic goals alone. Treatment selection should be individualized based on comorbid CKD, ASCVD, heart failure, obesity, or MASLD.

The document also highlights the importance of interdisciplinary care, routine screening for social determinants of health, and proactive management of associated conditions such as MASLD, obstructive sleep apnea, and adverse pregnancy outcomes.

“This guideline reflects a paradigm shift from siloed disease management to integrated care across the cardiovascular-kidney-metabolic spectrum,” the authors write, emphasizing the need to address excess and dysfunctional adiposity as a root cause of CKM progression.

Source: Ndumele CE, et al. (2026, June 9). Circulation. 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