Top Things to Know: Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-Kidney-Metabolic Syndrome for the Primary Prevention of Cardiovascular Disease

Updated: June 09, 2026

Prepared by Sadiya S. Khan, MD, MSc, FAHA, Northwestern Feinberg School of Medicine and Mu Huang, PhD, DPT, Science & Medical Advisor, American Heart Association

The American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations play a central role in risk assessment and management of cardiovascular-kidney-metabolic (CKM) syndrome.
The CKM syndrome staging construct integrates qualitative and quantitative risk assessment with progressively higher absolute risk for CVD in more advanced stages, emphasizing the importance of primordial, primary, and secondary prevention for CVD across the life course.
The 2026 AHA/ACC/ADA/ASN CKM Guideline recommends the use of the PREVENT equations to (1) define CKM syndrome stage 3, (2) decide when to test for subclinical cardiovascular disease (CVD); and (3) guide risk-based decision making for CKM therapies.
This AHA/ACC Scientific Statement outlines the rationale for the guideline’s framework for risk and benefit in selecting risk thresholds and provides practice guidance to support clinical implementation and shared decision-making.
Foundational prevention efforts apply to patients across CKM syndrome stages 0-4 and should include counseling on healthy lifestyle behaviors from Life’s Essential 8 and addressing social determinants of health
CKM syndrome stages 0–3 span the spectrum of primary prevention, with stage 3 representing those with known subclinical CVD or high predicted risk (PREVENT‑CVD ≥20% or very high-risk CKD), warranting more intensive preventive efforts.
In CKM syndrome stage 4, patients are at the highest risk and require intensive secondary prevention, including guideline-directed medical therapy and clinical optimization of CKM risk factors, including obesity, diabetes, chronic kidney disease (CKD), hypertension, and dyslipidemia.
Testing to detect subclinical or pre-heart failure (HF) with cardiac biomarkers or echocardiography when 10-year risk of HF with PREVENT-HF ≥5% can be beneficial to guide coordinated care for optimal HF prevention.
The PREVENT equations guide shared decision making to initiate cardioprotective CKM therapies (GLP‑1-based therapies, SGLT2i) for adults with diabetes and CKM syndrome stages 2–3 when 10‑year PREVENT‑CVD risk is ≥7.5%.
A risk based approach using the PREVENT equations maximizes absolute risk reduction, clinical benefit, and the cost effectiveness of CKM therapies.

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Citation

Khan SS, Bhave N, Blumenthal RS, Coresh J, Huang X, Joseph JJ, Khera A, Ho JE, Lloyd-Jones DM, Low Wang CC, Lu Y, Morris PB, Nasir K, Natarajan P, Rangaswami J, Rodriguez F, Sperling LS, Virani SS, Zhang S, Ndumele CE; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and the American College of Cardiology. Use of predicted risk and expected benefit to guide decision-making in cardiovascular-kidney-metabolic syndrome for the primary prevention of cardiovascular disease: a scientific statement from the American Heart Association and American College of Cardiology. Circulation. Published online Tuesday, June 9, 2026. doi: 10.1161/CIR.0000000000001447