The first clinical guideline for cardiovascular-renal-metabolic syndrome, or CKM syndrome, identifies excess weight, especially in the abdomen, as a key driver for the syndrome. The guideline aims to make people more aware of how heart disease, kidney disease and metabolic diseases (including diabetes and obesity) are linked.
Although many may not know it by name, nearly 9 out of 10 adults in the US have at least one of the conditions of CKM syndrome, which includes high blood pressure, abnormal cholesterol and other lipids, high glucose (sugar), reduced kidney function, and excess weight.
As obesity rates continue to rise, the guideline emphasizes supporting a healthy weight and calls on healthcare professionals to initiate prevention-focused conversations with their patients about how weight management now can help prevent future health problems.
“When it comes to CKM health, weight is not just a number on a scale—people of the same body weight can have very different health profiles,” said Chiadi E. Ndumele, MD, Ph.D., an American Heart Association volunteer and chair of the writing committee for the new guideline, which is jointly published by the American Heart Association and the American College of Cardiology. “Rather, what’s more important is how adipose tissue affects your metabolic health. This includes how your body manages blood sugar levels and how fat is used and stored.”
The CKM syndrome guideline replaces the 2013 guideline for the management of overweight and obesity issued by the Heart Association and other societies.
CKM syndrome was first defined by the American Heart Association in 2023.
CKM syndrome is a real, growing threat to public health.”
Chiadi E. Ndumele, director of obesity and cardiometabolic research, Johns Hopkins University, Baltimore
He noted that while many people may have said they have heart disease or kidney disease or diabetes, they may not know how closely linked all of these conditions are. Having one increases your risk of having others, a common challenge in CKM syndrome. Obesity also increases this risk.
“The challenge is how to connect the recommendations from different clinicians who may specialize in just one of these conditions,” he said. “So we’re trying to help clinicians from different specialties all speak a common language and be on the same page, especially when it comes to managing weight and its clinical consequences.”
Why talking about weight matters
“Maintaining a healthy weight has long been considered essential for heart health and the prevention of other chronic diseases. However, doctors don’t always bring up weight unless the patient brings it up, and often the focus is on appearance rather than health,” said Ambar Kulshreshtha, MD, Ph.D., a volunteer member of the Heart Association’s new guideline.
The new guideline gives health professionals a reason to discuss weight — not as an aesthetic issue, he said, but as a risk factor that can lead to organ damage.
“We say prevention is as important, if not more important, than treatment,” said Kulshreshtha, who is an associate professor in the department of family and preventive medicine at Emory School of Medicine in Atlanta.
In medical terms, the problem of being overweight or obese is when fatty tissue accumulates in the abdomen and adheres to organs in the abdomen. Such fat can cause inflammation, which leads to insulin resistance and problems with the way blood vessels dilate and constrict.
As these issues persist, CKM syndrome progresses to include diabetes, kidney disease, and eventual organ damage that may include kidney failure, heart failure, liver disease, heart attacks, or strokes.
If caught early, however, the disease process in CKM syndrome can be stopped or even reversed.
When explaining CKM syndrome to his own patients, Kulshreshtha likens the body’s blood vessels to plumbing in a house. Obesity causes inflammation, which he compares to rust.
“Rust can damage pipes, which is like your vascular system,” he said. “It can damage the pump, which is like your heart. And it can damage the filters, like your kidneys.”
Ndumele said the guideline offers ways for health professionals to discuss weight in non-judgmental ways. “It starts with a question: ‘Is now the right time to look at your weight and your health and how they might be affecting each other?’
The idea is to stop difficult problems before they start.
“The multiple consequences of obesity include diabetes, chronic kidney disease and cardiovascular disease. The guideline provides healthcare professionals with approaches to identify and manage these conditions,” Ndumele said. “I think every clinician knows patients with these conditions. They are often in and out of the hospital, and we share the patient’s frustration of managing multiple conditions and trying to stay healthy.”
Being overweight increases the risk of heart disease and stroke by at least 21% for men and 32% for women, according to the American Heart Association. Furthermore, every 5-point increase in body mass index (BMI) was associated with a 41% higher risk of heart failure.
Early conversations and “a growing array of tools,” Ndumele said, can prevent people from reaching these dangerous stages or even reverse CKM syndrome in its early forms.
“The guideline includes proven strategies to support healthy lifestyle practices as the foundation of CKM management,” he said. “It also plans to use increasingly effective drugs that benefit multiple body systems. These include SGLT2 inhibitors, GLP-1-based therapies, and nonsteroidal mineralocorticoid receptor antagonists. We want people in the community to be more aware of the fact that, ‘Hey, there’s a process here,’ and that with long-term intervention, ‘I can get dramatically better.’
Coordination of care
In addition to changing the way clinicians talk to patients about weight, the guidelines offer general principles to improve how health professionals work together to address obesity, diabetes, chronic kidney disease and heart disease.
“We, whether as primary care clinicians or subspecialists, operate from our own silos,” said Fatima Rodriguez, MD, MPH, vice chair of the guideline writing committee and chief of preventive cardiology at Stanford University. “But people with CKM syndrome don’t experience one condition at a time — often everything hits at once.”
She said working with other members of the healthcare team means patients are treated as a whole person.
“People appreciate being seen and treated holistically,” he said. “The idea is that patient care is a team effort, and the patient is the leader of the team.”
The guideline describes the benefits of using CKM coordinators, or navigators, to coordinate care between different health professionals and patients and to ensure follow-up care. As part of whole-person care, the guideline also emphasizes identifying social barriers to healthy living and quality health care and providing social support as needed.
“Research has shown that multidisciplinary teams have a dramatic impact on how people feel about their care and how successful treatment is,” Ndumele said. “Our goal here is to change some of our paradigms, not just wait for disease to come to us, but rather help people prevent a lot of disease in the long term.”
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