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, identifies excess weight, particularly abdominal fat, as a key driver of the syndrome. The guideline aims to raise awareness that heart disease, kidney disease, and metabolic conditions such as diabetes and obesity are interconnected, with nearly 9 in 10 U.S. adults having at least one of these conditions.
As obesity rates continue to rise, the guideline emphasizes supporting a healthy weight and encourages healthcare professionals to initiate prevention-focused conversations with patients about how managing weight can prevent future health 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 Chiadi E. Ndumele, M.D., Ph.D., chair of the writing committee. "Rather, what’s most important is how fat tissue affects your metabolic health."
The guideline replaces the 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. CKM syndrome was first defined by the American Heart Association in 2023. Ndumele noted that while many people may have been told they have heart disease, kidney disease, or diabetes, they may not realize how closely these conditions are connected. Having one increases the risk of developing others, with obesity raising that risk further.
The guideline provides a common language for clinicians across specialties to manage weight and its clinical consequences. "The challenge is how to connect the recommendations from different clinicians who may specialize in only one of these conditions," Ndumele said. "So, we are trying to help clinicians from various specialties all speak in a common language."
Maintaining a healthy weight has long been considered essential for heart health, but doctors often avoid discussing weight unless patients bring it up. The new guideline gives healthcare professionals a reason to discuss weight as a risk factor that can lead to organ damage, not as a cosmetic issue. "We are saying that prevention is as important, if not more important, than treatment," said Ambar Kulshreshtha, M.D., Ph.D., a volunteer member of the Heart Association’s Council on Quality of Care and Outcomes Research and a primary care physician who helped write the guideline.
Medically, the problem with overweight or obesity is when fat tissue accumulates in the belly and clings to organs, causing inflammation that leads to insulin resistance and vascular issues. If caught early, the disease process in CKM syndrome can be stopped or even reversed. The guideline offers ways for healthcare professionals to discuss weight non-judgmentally, starting with questions like, "Is now a good time for us to address your weight and your health and how they may be affecting each other?"
Excess weight increases heart disease and stroke risk by at least 21% for men and 32% for women, and each 5-unit increase in BMI is associated with a 41% higher risk of heart failure. The guideline includes proven strategies to support healthy lifestyle practices and outlines effective medications such as SGLT2 inhibitors, GLP-1 based therapies, and nonsteroidal mineralocorticoid receptor antagonists. More information is available at heart.org.
Coordinating care across specialties is crucial. "We, as either primary care clinicians or sub-specialists, operate from our own silos," said Fatima Rodriguez, M.D., M.P.H., vice-chair of the guideline 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 recommends using CKM coordinators or navigators to coordinate care and ensure follow-up, as well as addressing social barriers to healthy lifestyle and quality healthcare. Research shows interdisciplinary teams dramatically impact care success and patient satisfaction.
