Top Things to Know: A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome

Published: October 09, 2023

  1. The scientific statement provides a conceptual framework that reflects our current scientific understanding of cardiovascular-kidney-metabolic (CKM) syndrome as a multi-directional relationship among excess and dysfunctional adiposity, metabolic risk factors, chronic kidney disease and the cardiovascular system, with significant related implications for premature morbidity and mortality.
  2. It details key gaps in our scientific understanding of CKM syndrome, including mechanisms of cardiovascular disease (CVD) development in CKM syndrome; factors contributing to the heterogeneity within CKM syndrome, including among individuals within the same weight category; mechanisms underlying bi-directional cardiovascular-kidney interactions; and the scarcity of studies describing competing risk in CKM syndrome.
  3. It describes a crosswalk of major guidelines, performed by a multidisciplinary group of experts, on the screening, prevention and management of atherosclerotic cardiovascular disease (ASCVD), heart failure and atrial fibrillation in patients with CKM risk factors.
  4. The statement describes key evidence and existing clinical guidelines supporting population-based CKM-related screening.
  5. It highlights key gaps and discrepancies related to screening for CKM syndrome, including approaches for screening in early life; strategies for metabolic risk factor and CKD screening in adult populations; the utility of screening for social determinants of health (SDoH); and optimal approaches to identifying subclinical heart failure in the population.
  6. It details evidence supporting the overarching considerations of promoting interdisciplinary care and addressing the SDoH factors for optimal care of patients with CKM syndrome.
  7. It describes evidence supporting the prevention of CVD and progressive kidney failure in the early stages of CKM syndrome and the unique considerations for managing CVD in individuals with coexisting metabolic risk factors and/or CKD.
  8. It details key gaps in the evidence for CKM prevention and management, including: 1) evidence for inter-disciplinary care models; 2) the clinical impact of early life screening and prevention; 3) optimal strategies to support lifestyle change and weight loss; 4) optimal approaches for selecting cardioprotective anti-hyperglycemic therapies in those at risk for CVD; 5) optimal approaches for selecting cardioprotective hyperglycemic therapies in those with existing CVD; 6) the use of lipid-lowering therapies beyond statins in those with diabetes and/or high CKM risk; and 7) management of CVD in patients with CKD.
  9. The statement shares a path forward for CKM syndrome science and care, including cross-disciplinary investigations to better understand the multi-system interplay that is inherent to CKM syndrome; effectiveness studies to support implementation in real-world settings; the use of new risk prediction algorithms to help guide the allocation of cardioprotective therapies in CKM syndrome, with a focus on net clinical benefit; and the need to address the historic influx of patients with CKM syndrome as a consequence of the epidemics of obesity and diabetes.
  10. The statement emphasizes the need for holistic approaches to prevention and management to fully and equitably address the population impact of CKM syndrome, aiming to advance cardiovascular health for all.


Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, Coresh J, Mathew RO, Baker-Smith CM, Carnethon MR, Despres J-P, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV; on behalf of the American Heart Association. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association [published online ahead of print October 9, 2023]. Circulation. doi: 10.1161/CIR.0000000000001184