New clinical guidelines target interconnected heart, kidney and metabolic risks

The American Heart Association and the American College of Cardiology, along with two other leading medical organizations have developed the first-ever guideline aimed at preventing and managing cardiovascular-kidney-metabolic (CKM) syndrome, an interconnected set of health conditions that significantly increase the risk of multiorgan complications and negative cardiovascular outcomes. 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 (sugar) or reduced kidney function. 

Recommendations to help clinicians and individuals identify CKM syndrome risk earlier and take action to protect long-term heart, metabolic and kidney health are detailed in this new clinical practice guideline, published today in the American Heart Association's flagship peer-reviewed journal Circulation and in JACC, the flagship journal of the American College of Cardiology.

According to recent statistics from both the American Heart Association and the American College of Cardiology, 40% of U.S. adults and 21% of children and adolescents in the U.S. have obesity, defined as excess body fat that presents a risk to health. Obesity is a risk factor for high blood pressure, Type 2 diabetes, metabolic dysfunction, cardiovascular disease and kidney disease. 

Heart, kidney, and metabolic conditions don't occur in isolation-they are deeply connected. 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 or a major cardiac event occurs."

Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, chair of the guideline writing committee and the director of obesity and cardiometabolic research, Johns Hopkins School of Medicine, Baltimore

What are the stages of cardiovascular-kidney-metabolic (CKM) syndrome?

There are four stages of CKM syndrome. These stages identify risk and tailor prevention strategies to slow-or even reverse-progression of CKM syndrome:

• Stage 1: individuals with overweight/obesity or prediabetes, but without other metabolic risk factors, kidney disease or cardiovascular disease
• Stage 2: includes people with one or more metabolic risk factors (such as high blood pressure, abnormal lipid levels, Type 2 diabetes or metabolic syndrome) and/or kidney disease, but without cardiovascular disease
• Stage 3: people with subclinical (asymptomatic) cardiovascular disease and CKM risk factors; or those with the risk equivalents of very-high-risk chronic kidney disease or high predicted 10-year risk of cardiovascular disease (based on the PREVENT-CVD equations)
• Stage 4: individuals with diagnosed cardiovascular disease (coronary heart disease, heart failure, stroke, peripheral artery disease and/or atrial fibrillation) with overweight or obesity, other metabolic risk factors or kidney disease

Key highlights from the guideline include:

• Improved risk assessment using the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations to estimate 10- and 30-year risk for cardiovascular disease, which can help guide individualized lifestyle and treatment plans. PREVENT includes kidney and metabolic health factors in the equations for a more comprehensive and precise estimation of risk compared with previous tools.
• Screening for social factors that affect health, including food insecurity, housing instability and financial strain, is also recommended to identify individuals at higher risk of developing CKM syndrome.
• Coordinated interdisciplinary care and healthy lifestyle behaviors, including attention to physical activity, nutrition, weight, blood pressure, blood sugar and cholesterol, are emphasized to prevent and manage CKM syndrome.
• In conjunction with lifestyle management, additional treatment options for CKM syndrome include medications and surgical therapies, such as medications to manage blood pressure, cholesterol, blood sugar and weight, to protect the heart and kidneys. For the first time, GLP-1-based therapies are recommended for select individuals with obesity and/or Type 2 diabetes, and other risk factors for cardiovascular disease to reduce the risk of cardiac events. Metabolic and bariatric surgery may also be used to treat CKM syndrome.

What should people do to prevent CKM syndrome?

The guideline underscores that lifestyle modification can make a meaningful difference in overall health. Taking action early can help prevent a heart attack, heart failure, stroke or kidney failure. Individuals are encouraged to follow the American Heart Association's Life's Essential 8, measures recommended to improve and maintain cardiovascular health.

Life's Essential 8 focuses on regular physical activity, heart-healthy eating, maintaining a healthy weight, managing blood pressure, blood sugar and cholesterol, as well as avoiding tobacco and getting enough quality sleep. These are all powerful tools to improve cardiovascular-kidney-metabolic health. These actions reduce the risk of heart disease and also support kidney and metabolic health across the lifespan."

Fátima Rodriguez, M.D., M.P.H., FAHA, FACC, vice chair of the writing committee and associate professor of cardiovascular medicine, Stanford Medicine, Stanford, California

The guideline, led by the American Heart Association and the American College of Cardiology Joint Committee on Clinical Practice Guidelines, was developed in collaboration with and endorsed by the American Diabetes Association; the American Diabetes Association Obesity Association; and the American Society of Nephrology.