Highlights
- The first guideline for cardiovascular-kidney-metabolic syndrome (CKM syndrome), published today by American Heart Association and the American College of Cardiology, identifies obesity as a key metabolic factor in the syndrome's development and progression.
- The guideline urges earlier, prevention-focused conversations about weight and metabolic health.
- The guideline says that using navigators or care coordinators improves care by helping coordinate care between the patient, primary care and specialty clinicians.
DALLAS, June 9, 2026 — The first-ever clinical guideline for cardiovascular-kidney-metabolic syndrome, or CKM syndrome, identifies excess weight, especially in the abdomen, as a key driver for the syndrome. The guideline aims to make people more aware of how heart disease, kidney disease and metabolic conditions (including diabetes and obesity) are interconnected.
Though many might not know it by name, nearly 9 in 10 adults in the U.S. have at least one of the conditions within CKM syndrome, which includes high blood pressure, abnormal cholesterol and other lipids, high blood glucose (sugar), reduced kidney function and excess weight.
As obesity rates continue to rise, the guideline underscores supporting a healthy weight and calls on healthcare professionals to begin prevention-focused conversations with their patients about how managing weight now can help 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., an American Heart Association volunteer and chair of the writing committee for the new guideline, which is jointly issued by the American Heart Association and the American College of Cardiology. "Rather, what's most important is how fat tissue affects your metabolic health. This includes how your body manages blood sugar levels and how fat is used and stored."
The CKM syndrome guideline replaces the 2013 guideline for managing overweight and obesity issued by the Heart Association and other societies.
CKM syndrome first was defined by the American Heart Association in 2023.
"CKM syndrome is a real, rising public health threat," said Ndumele, who is director of obesity and cardiometabolic research at Johns Hopkins University in Baltimore.
He noted that while many people may have been told they have heart disease or kidney disease or diabetes, they may not know how closely all of these conditions are connected. Having one increases the risk of having others, a common challenge in CKM syndrome. Having obesity also raises that risk.
"The challenge is how to connect the recommendations from different clinicians who may specialize in only one of these conditions.," he said. "So, we are trying to help clinicians from various specialties all speak in a common language and be on the same page, especially when it comes to managing weight and its clinical consequences."
How does weight impact health?
Why it matters to talk about weight
"Maintaining a healthy weight has long been seen as essential to heart health and preventing other chronic illness. However, doctors don't always raise the topic of weight unless a patient brings it up, and often the focus is on appearance rather than health," 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 also helped write the new guideline.
The new guideline gives healthcare professionals a reason for discussing weight – not as a cosmetic issue, he said, but as a risk factor that can lead to organ damage.
"We are saying that prevention is as important, if not more important, than treatment," said Kulshreshtha, who is an associate professor in the department of family and preventive medicine at the Emory School of Medicine in Atlanta.
In medical terms, the problem with having overweight or obesity is when fat tissue accumulates in the belly and clings to organs in the abdomen. Such fat can cause inflammation, which leads to insulin resistance and problems with the way blood vessels dilate and contract.
As these issues persist, CKM syndrome progresses to include diabetes, kidney disease and eventually organ damage that may include kidney failure, heart failure, liver disease, heart attacks or strokes.
If caught early, however, the disease process in CKM syndrome can be stopped or even reversed.
How is weight measured to see if you're at risk for CKM syndrome?
When explaining CKM syndrome to his own patients, Kulshreshtha likens the body's blood vessels to plumbing in a house. Obesity causes inflammation, which he compares to rust.
"The rust can damage the pipes, which is like your vascular system," he said. "It can damage the pump, which is like your heart. And it can damage the filters, like your kidneys."
Ndumele said the guideline offers ways for healthcare professionals to discuss weight in non-judgmental ways. "It starts with a question of, 'Is now a good time for us to address your weight and your health and how they may be affecting each other?'"
The idea is to stop hard-to-treat problems before they start.
"The multiple consequences of obesity include diabetes, chronic kidney disease and cardiovascular disease. The guideline provides healthcare professionals with approaches for identifying and managing these conditions," Ndumele said. "I think every clinician knows of patients with these conditions. They're often in and out of the hospital, and we share the patient's frustration in managing multiple conditions and trying to stay healthy."
Excess weight increases the risk of heart disease and stroke by at least 21% for men and 32% for women, according to the American Heart Association. In addition, each 5-unit increase in body mass index (BMI) is associated with a 41% higher risk of heart failure.
Early conversations and "an increasing array of tools," Ndumele said, can keep people from getting to those dangerous stages or even reverse CKM syndrome in its early forms.
"The guideline includes proven strategies to support healthy lifestyle practices as the foundation of CKM syndrome management," he said. "It also outlines the use of increasingly effective medications that benefit multiple body systems. These include SGLT2 inhibitors, GLP-1 based therapies and nonsteroidal mineralocorticoid receptor antagonists. We want people in the community to be more aware of the fact that, 'Hey, there's a process here,' and that if there's intervention earlier, 'I can dramatically improve my long-term outcomes.'"
Learn about a weight management care team and treatment for weight management.
Coordinating the care
In addition to changing how clinicians talk to patients about weight, the guidelines offer general principles to improve the way healthcare professionals work together to address obesity, diabetes, chronic kidney disease and heart disease.
"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 and chief of preventive cardiology at Stanford University. "But people with CKM syndrome don't experience one condition at a time — it often all hits at the same time."
She said that working with other members of the healthcare team means patients are treated as a whole person.
"People appreciate being seen and treated holistically," she said. "The idea is that patient care is a team effort, and the patient is team captain."
The guideline outlines the benefits of using CKM coordinators, or navigators, to coordinate care between the different healthcare professionals and patients, and to ensure follow-up care. As part of whole-person care, the guideline also emphasizes identifying social barriers to healthy lifestyle and quality healthcare, and providing social support as needed.
"Research has shown that interdisciplinary teams make a dramatic impact on how people feel about their care and on how successful treatment is," Ndumele said. "Our goal here is to shift some of our paradigms, to not just wait for the disease to come to us, but rather to help individuals prevent a lot of disease in the long term."
In 2024, the American Heart Association launched the CKM Health Initiative to provide a path forward for patients, communities and healthcare professionals to improve diagnosis and treatment for CKM syndrome. Learn more about it on the initiative's page at heart.org.
