The recent release of the 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome marked an important step in defining evidence-based approaches to CKM prevention, risk assessment and treatment. A new CKM Syndrome Guideline Spotlight Issue published Aug. 4 in JACC explores those challenges and opportunities from a variety of perspectives. Together, the commentaries provide a closer look at clinical considerations addressing obesity, heart failure (HF) prevention and more.

Obesity Management

In a commentary article about the practicalities of obesity management for the cardiologist, Neha J. Pagidipati, MD, FACC, zeroes in on obesity management as a critical inclusion that must be incorporated into routine cardiovascular care. Pagidipati summarizes Guideline recommendations and offers practical guidance for cardiologists, including focusing on a patient-centered approach, prioritizing lifestyle modification, using GLP-1-based therapies when appropriate, and considering metabolic and bariatric surgery for eligible patients. Included alongside the guidance, Pagidipati provides a "Quick Start" companion with examples of conversational prompts that keep the dialogue patient-centered, nonjudgmental and goal-oriented. "Managing obesity may be new for many cardiologists," Pagidipati writes, "But it is not hard – and it can be incredibly rewarding."

HF Prevention

Targeting CKM conditions provide a new opportunity to tackle the "daunting challenge" of HF prevention, Mark C. Petrie, MD, et al., note in another commentary article. The commentary focuses on the new prevention framework outlined in the Guideline and the incorporation of the PREVENT-HF risk score to identify patients who may benefit from additional evaluation. Under the Guideline, patients with a PREVENT-HF score of ≥5% 10-year risk are candidates for cardiac biomarker (NT-proBNP and/or high-sensitivity troponin) measurement. The commentary authors raise additional, important questions on PREVENT-HF's possible limitations, best screening strategies, incorporation of biomarkers and the need for further research. "The journey from recognition of risk to successful prevention is a long one and careful steps must be taken to ensure success," write Petrie, et al.

Pharmacotherapy

In a commentary article examining pharmacotherapy for the management of type 2 diabetes (T2D) and CKM syndrome, Ambarish Pandey, MD, and Kershaw Patel, MD, discuss the Guideline recommendations for SGLT2 inhibitors and GLP-1-based therapies, which ties treatment decisions to CKM stage and estimated cardiovascular risk, and place these within existing trial evidence, noting that many lower-risk patients with T2D remain underrepresented in studies evaluating CKM therapies. They commend the Guideline as an important reframing of T2D not as an isolated metabolic disorder based on glycemic control alone but one that will benefit from other proven cardiovascular and renal therapies. However, the authors suggest that the current treatment allocation strategy based on the ≥7.5% PREVENT-CVD 10-year risk threshold may be too restrictive and call for further research. "While it represents the early stages of precision medicine, the CKM syndrome guideline represents an important step forward for personalized management of T2D," they conclude.

Read the full CKM Syndrome Guideline Spotlight Issue published in JACC to better understand the recommendations and realities of implementation, including additional perspectives on incorporating liver management in the cardiometabolic workflow, addressing social drivers of health, the need for interdisciplinary care models, opportunities provided by the ACCESS model, the role of the cardiologist as champion of CKM health, and more.

Also access a new case scenario slide set on the CKM Syndrome Guideline Hub that illustrates the practical application of the Guideline through real-world patient case scenarios. The slide set walks through key clinical decision points, and evidence-based management strategies anchored to key guideline recommendations. Available to download for rounds, presentations or other educational activities, the cases help clinicians identify, stage and manage CKM syndrome to improve cardiovascular, kidney and metabolic health outcomes.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Glucagon-Like Peptide 1, Biomarkers, Kidney, Obesity, Heart Disease Risk Factors, Heart Failure, Patient-Centered Care, Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Glycemic Control, Obesity Management