Cardiovascular disease remains the leading cause of death worldwide, while chronic kidney disease, obesity, and type 2 diabetes continue to rise across many countries. Increasingly, researchers recognise that these conditions are closely connected, often developing together and accelerating one another. Addressing them in isolation can miss opportunities to prevent serious illness and improve long-term health outcomes.
To help clinicians better identify and manage these overlapping risks, leading health organisations have released the 2026 Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome. Developed by the American Heart Association, American College of Cardiology, American Diabetes Association, and American Society of Nephrology, the guideline provides a comprehensive framework for preventing and managing these interconnected conditions. Among its contributors is Dr Salim Virani, Professor of Cardiology and Population Health and Vice Provost Research at Aga Khan University.
CKM syndrome describes the close relationship between excess body weight, diabetes, kidney disease, and cardiovascular disease. Rather than viewing these conditions separately, the guideline encourages clinicians to assess how they interact and contribute to a person's overall health risk.
A major feature of the guideline is a staging system that helps identify patients earlier in the disease process. Individuals are classified along a spectrum ranging from those with no major risk factors to those with established cardiovascular disease and kidney failure. This approach aims to support earlier intervention before irreversible damage occurs.
The guideline places strong emphasis on prevention through healthy lifestyle habits, including maintaining a healthy weight, regular physical activity, nutritious diets, and tobacco avoidance. It also highlights the growing role of therapies that can simultaneously protect the heart, kidneys, liver, and metabolic health, particularly among people with diabetes and chronic kidney disease.
“These guidelines recognise that heart disease, kidney disease, obesity, metabolic liver disease, and diabetes are deeply interconnected," said Dr Virani. “By identifying risk earlier and taking a more integrated approach to prevention and treatment, we have an opportunity to improve outcomes, reduce complications across several body systems, and help people live longer, healthier lives."
The guideline also underscores the importance of coordinated, interdisciplinary care and addressing social determinants that influence health. By bringing together the latest evidence into a practical framework, it aims to help clinicians deliver more personalised care while reducing the growing global burden of cardiovascular, kidney, and metabolic disease.
