A Unified Approach to Cardiovascular Risk Reduction

Guidelines serve as complementary resources for different clinical decisions.

• The 2025 High Blood Pressure Guideline provides recommendations for the prevention, detection, evaluation and management of high blood pressure in adults.
• The 2026 Dyslipidemia Guideline provides recommendations for evaluating, managing and monitoring dyslipidemia, including high LDL-C, hypertriglyceridemia and elevated Lp(a).
• The 2026 CKM Syndrome Guideline provides an integrated approach to assessing cardiovascular, kidney and metabolic health, including CKM syndrome staging, risk assessment and management across the CKM syndrome spectrum.

In practice: Assess the patient's overall cardiovascular, kidney and metabolic health and risk, then apply the guideline recommendations relevant to the clinical decisions at hand.

Resource: PLACEHOLDER for final file (WF1973436)

No. These guidelines address different but related aspects of cardiovascular risk and care.

The 2026 CKM Syndrome Guideline emphasizes the interconnections among metabolic risk factors, chronic kidney disease and cardiovascular disease and provides a framework that includes CKM syndrome staging and cardiovascular risk assessment. The High Blood Pressure and Dyslipidemia guidelines provide more specific recommendations for managing blood pressure and lipid-related risk factors, respectively.

The takeaway: A single patient may have care informed by more than one guideline.

Use the 2026 CKM Syndrome Guideline to assess CKM health, determine CKM syndrome stage, quantify cardiovascular risk with PREVENT where appropriate, evaluate CKM risk factors and guide integrated management and care coordination.

Use the 2025 High Blood Pressure Guideline for decisions about blood pressure classification, evaluation, treatment and control, including when cardiovascular risk should inform initiation of antihypertensive medication.

Use the 2026 Dyslipidemia Guideline for decisions about lipid assessment and lipid-lowering treatment, including LDL-C and non-HDL-C goals, PREVENT-ASCVD risk assessment, Lp(a), ApoB and selective use of coronary artery calcium (CAC).

The takeaway: Start with the patient's overall clinical picture, then use the guideline or guidelines that address the specific decisions you need to make.

CKM health should be considered across the life course because cardiovascular disease, kidney disease and metabolic risk factors are interconnected. The CKM Syndrome Guideline recommends CKM syndrome staging in youths and adults and routine assessment of risk factors in adults.

For patients with overlap among type 2 diabetes, chronic kidney disease and cardiovascular disease, the guideline also recommends interdisciplinary care and emphasizes coordination of evidence-based care.

Think beyond a single condition: Understanding the patient's CKM health can help identify opportunities to prevent progression, reduce cardiovascular events and loss of kidney function, and promote CKM syndrome stage regression.

Resource: Talking With a Health Care Professional About Cardiovascular-Kidney-Metabolic Syndrome (CKM) Health

Assess cardiovascular, kidney and metabolic risk together. The CKM Syndrome Guideline recommends routine assessment for CKM risk factors among adults, along with evaluation of social determinants of health that may affect CKM syndrome and its complications.

The guideline also recommends CKM syndrome staging and, for individuals at risk for CVD in CKM syndrome stages 0–3, quantifying risk with the PREVENT equations to estimate 10- and 30-year risk for ASCVD, heart failure and total CVD.

CKM syndrome staging helps clinicians characterize a patient's CKM health and tailor therapy to absolute risk. The guideline recommends staging to help identify opportunities to prevent progression, reduce risk of cardiovascular events and kidney function loss, and promote stage regression through lifestyle change and weight loss.

PREVENT estimate also contributes to staging. A 10-year PREVENT-CVD estimate ≥20% is one criterion for CKM syndrome Stage 3, while PREVENT is not indicated for people with existing cardiovascular disease in CKM syndrome Stage 4.

Use the PREVENT equations to estimate cardiovascular risk in appropriate patients without known cardiovascular disease and to inform primary prevention-focused decisions in alignment with the relevant clinical guideline.

The PREVENT equations estimate 10- and 30-year risk and provide outcome-specific estimates for total CVD (PREVENT-CVD), atherosclerotic cardiovascular disease (PREVENT-ASCVD) and heart failure (PREVENT-HF). The equations are validated for adults ages 30–79 years without known CVD.

The PREVENT equations are intended to address the clinical question.

• For blood pressure treatment decisions: The 2025 High Blood Pressure Guideline uses PREVENT-CVD. Among selected adults with average BP ≥130/80 mm Hg, a 10-year PREVENT-CVD risk ≥7.5% is one indication for initiating medication in addition to lifestyle intervention.
• For primary-prevention lipid decisions: The 2026 Dyslipidemia Guideline uses PREVENT-ASCVD. PREVENT-ASCVD informs risk-based decisions about lipid-lowering therapy.
• For CKM syndrome: The 2026 CKM Syndrome Guideline uses the PREVENT estimates for several purposes, including CKM syndrome staging, consideration of additional testing for subclinical CVD and guiding risk-based CKM therapy decisions.

The PREVENT equations are a type of risk assessment tool, but PREVENT-CVD, PREVENT-ASCVD and PREVENT-HF answer different clinical questions.

Each guideline uses PREVENT to inform different clinical decisions and outcomes. Examples:

• The 2025 High Blood Pressure Guideline uses 10-year PREVENT-CVD risk ≥7.5% as one criterion for initiating antihypertensive medication in adults with Stage 1 hypertension.
• For lipid management, the 2025 Dyslipidemia Guideline uses PREVENT-ASCVD: lipid-lowering therapy is recommended for applicable primary-prevention adults with 10-year ASCVD risk ≥5% and is reasonable at 3% to <5% following clinician-patient discussion.
• The 2026 CKM Syndrome Guideline uses a 10-year PREVENT-CVD estimate ≥20% as one criterion for CKM syndrome Stage 3, while a ≥7.5% predicted 10-year CVD risk further informs prioritization of CKM pharmacotherapies.

The takeaway: Don't compare PREVENT thresholds in isolation. Use the risk outcome and threshold specified for the decision addressed by the relevant guideline.

 

When the initial risk estimate does not provide enough clarity for a treatment decision, guideline-specific recommendations can help determine whether additional information may refine risk.

For dyslipidemia, the guideline describes a Calculate → Personalize → Reclassify approach: calculate 10-year ASCVD risk, personalize that estimate by considering factors not included in PREVENT-ASCVD, and potentially reclassify risk with selective use of CAC before reassessing the treatment recommendation.

In CKM syndrome, selected patients may benefit from additional testing after quantitative risk assessment. The guideline notes that CAC can be beneficial when 10-year PREVENT-ASCVD risk is 3% to <10% and clinical decision-making remains uncertain; cardiac biomarkers can be beneficial when 10-year PREVENT-HF risk is ≥5%.

The takeaway: Calculate risk first, then use the recommendations in the applicable guideline to determine whether further personalization or reclassification is warranted.

Foundational prevention applies across CKM syndrome stages 0–4, including healthy lifestyle behaviors and attention to social determinants of health.

The 2025 High Blood Pressure Guideline likewise recommends lifestyle approaches for prevention or treatment of elevated blood pressure and hypertension. The 2026 Dyslipidemia Guideline emphasizes earlier intervention, including healthy lifestyle behaviors and earlier treatment where appropriate to reduce lifetime exposure to atherogenic lipoproteins.

For BP classification, treatment thresholds, BP goals, medication decisions and management of hypertension. The overarching treatment goal in the 2025 High Blood Pressure Guideline is <130/80 mm Hg for adults, with additional considerations for specified populations.

Resources: Top Things to Know: Guideline on the Management of High Blood Pressure

For evaluation and management of dyslipidemia, including risk-based lipid-lowering decisions, LDL-C and non-HDL-C goals, Lp(a), ApoB and selective use of CAC.

Resources: Top Things to Know: Guideline on the Management of Dyslipidemia; 2026 Dyslipidemia Guideline

Apply both within the patient's overall cardiovascular and CKM risk picture rather than treating the conditions as isolated problems.

Resource: Top Take-Home Messages from the 2026 Guideline for Cardiovascular-Kidney-Metabolic Syndrome (CKM Syndrome (PDF)