AHA says new CKM syndrome links heart, kidney, and metabolic health

Nearly 90% of U.S. adults meet the criteria for cardiovascular-kidney-metabolic syndrome, a framing that pulls heart disease, kidney disease, obesity and Type 2 diabetes into one clinical picture instead of separate silos. The American Heart Association first defined the condition in a presidential advisory published Oct. 9, 2023 in Circulation, describing a staged process that runs from Stage 0, with no risk factors, to Stage 4, the highest-risk stage and possible kidney failure.

About 1 in 3 U.S. adults have at least three risk factors for CKM syndrome, while the broader criteria capture about 90% of adults. The mix of metabolic, kidney and cardiovascular risks is common, often quiet, and often missed until disease is advanced.

The American Heart Association launched its CKM Health Initiative in 2024 as a four-year effort to close care gaps and improve coordination across clinicians and communities. The initiative is built around earlier screening, shared risk assessment and more consistent follow-up, including a nationwide Groundbreakers program that aims to reach 150 sites across the United States. The framework treats CKM as a life-course issue, because the processes behind it can build long before symptoms appear.

Doctors are being steered toward the AHA’s PREVENT calculator, which estimates 10-year and 30-year risk for total cardiovascular disease, atherosclerotic cardiovascular disease and heart failure. Under the 2026 AHA and American College of Cardiology guideline, people in CKM stages 0 through 3 should have their risk quantified with PREVENT, and a predicted 10-year cardiovascular disease risk of at least 20% is one criterion for Stage 3. The calculator can also incorporate kidney and metabolic markers such as urine albumin-creatinine ratio, hemoglobin A1c and the social deprivation index.