Cardiovascular Kidney Metabolic Health: A Presidential Advisory From the AHA

Published: October 09, 2023

A graphic image illustrating the stages of Cardiovascular-Kidney-Metabolic Syndrome. Stage 0 shows a graphic image of a healthy woman jogging and the logo for the AHA's Life's Essential 8 calculator, which focuses on primordial prevention and preserving cardiovascular health. From that starting point, a white arrow points into a yellow zone for Stage 1: Excess/Dysfuntional Adipose Tissue, which shows a cutout of an overweight/obese figure, a microscopic view of dysfunctional adipose tissue, and feet on a scale over the caption: Overweight/obesity, Abdominal obeisty, Impared glucose tolerance. From there, a light yellow arrow points into a darker yellow zone for Stage 2: Metabolic Risk Factors and CKD showing an illustration of the interactions between hypertension (blood pressure cuff), metabolic syndrome (cell slide), moderate to high-risk CKD (kidneys), type 2 diabetes (blood sugar reading), and hypertriglyuceridemia (molecular sugars). From there, a dark yellow arrow points into an orange zone for Stage 3: Subclinical CVD in CK Syndrome illustrated with scans showing evidence of subclinical ASCVD and subclinical HF. The orange zone further describs risk equivalents of subclinical CVD in CKM Stage 3: 1) Very high-risk CKD (G stage 4 and 5 CKD or by KDIGO heat map) and 2) High predicted risk for CVD using risk calculator. Finally, an orange arrow points into the red zone for Stage 4: Clinical CVD in CKM Syndrome showing five medical images representing CHD (injured heart), HF (enlarged heart), PAD (blocked arteries in the leg), Stroke (injured brain), and Afib (arrhhythmia reading).
  • Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder with connections among heart disease, kidney disease, diabetes, and obesity.
  • This presidential advisory describes the urgency of CKM syndrome, which disproportionately affects disenfranchised populations, suggests consensus on defining and staging the syndrome, offers suggestions for screening, and provides approaches and algorithms for each stage. It also describes the interdisciplinary team approach needed to effectively treat CKM syndrome, emphasizes the importance of addressing social determinants of health, identifies shortcomings in current efforts, and names knowledge gaps.
  • The advisory is supported by a scientific statement that summarizes evidence related to the science, screening, prevention, and management of CKM syndrome and the related supporting materials below.

Read the full Presidential Advisory in Circulation

Read the Synopsis of the Evidence in Circulation