The American Heart Association and the American College of Cardiology have issued the first-ever clinical guideline for cardiovascular-kidney-metabolic syndrome, or CKM syndrome, which identifies excess weight, particularly abdominal fat, as a key driver of the syndrome. The guideline, published June 9, 2026, aims to raise awareness of the interconnections between heart disease, kidney disease, and metabolic conditions such as diabetes and obesity. Nearly 9 in 10 U.S. adults have at least one condition within CKM syndrome, including high blood pressure, abnormal cholesterol, high blood glucose, reduced kidney function, or excess weight.
According to Chiadi E. Ndumele, M.D., Ph.D., chair of the writing committee, weight is not just about a number on a scale; what matters is how fat tissue affects metabolic health, including blood sugar management and fat storage. The guideline replaces the 2013 obesity management guideline and underscores the need for earlier, prevention-focused conversations about weight. CKM syndrome, first defined by the American Heart Association in 2023, is a rising public health threat, and having one condition increases the risk of others.
Ambar Kulshreshtha, M.D., Ph.D., a primary care physician who helped write the guideline, emphasized that discussing weight is not cosmetic but a risk factor that can lead to organ damage. Abdominal fat causes inflammation, leading to insulin resistance and vascular problems, which can progress to diabetes, kidney disease, heart failure, and stroke. However, early intervention can stop or reverse the disease process.
The guideline provides non-judgmental approaches for healthcare professionals to discuss weight, such as asking, 'Is now a good time for us to address your weight and your health and how they may be affecting each other?' Excess weight increases heart disease and stroke risk by at least 21% for men and 32% for women, and each 5-unit increase in BMI is associated with a 41% higher risk of heart failure, according to the American Heart Association.
The guideline also recommends using navigators or care coordinators to improve coordination between primary care and specialists. Fatima Rodriguez, M.D., M.P.H., vice-chair of the committee, noted that people with CKM syndrome experience multiple conditions simultaneously and benefit from holistic care. The guideline emphasizes identifying social barriers to healthy lifestyle and providing social support.
The American Heart Association launched the CKM Health Initiative in 2024 to improve diagnosis and treatment. For more information, visit the initiative’s page at heart.org. The full guideline is available in Circulation.
