In a significant step toward advancing preventive healthcare, the American Heart Association (AHA) and the American College of Cardiology (ACC) have released a new scientific statement, published in Circulation, advocating a comprehensive, risk-based approach to the prevention and management of cardiovascular-kidney-metabolic (CKM) syndrome. The statement emphasizes the use of advanced risk prediction tools to guide treatment decisions and improve outcomes for millions of individuals at risk of cardiovascular disease, chronic kidney disease, obesity, diabetes, and heart failure.
The recommendations build upon the recently published AHA/ACC hypertension (2025) and dyslipidemia (2026) guidelines, both of which incorporate quantitative cardiovascular risk assessment into clinical decision-making. Central to the new framework are the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, a suite of validated prediction models that estimate an individual’s likelihood of developing major cardiovascular conditions. The framework includes three complementary models: PREVENT-CVD for overall cardiovascular disease risk, PREVENT-ASCVD for atherosclerotic cardiovascular disease risk, and PREVENT-HF for heart failure risk. Together, these models enable clinicians to assess multiple cardiovascular outcomes and tailor preventive strategies according to each patient’s overall risk profile.
Traditionally, cardiovascular risk assessment has focused primarily on atherosclerotic cardiovascular disease (ASCVD). However, mounting evidence indicates that cardiovascular disease, chronic kidney disease, obesity, diabetes, and heart failure frequently coexist and share common biological pathways and risk factors. This interconnected cluster of conditions is collectively known as cardiovascular-kidney-metabolic syndrome, highlighting the need for prevention strategies that address these disorders as part of a single continuum rather than as isolated diseases.
A major innovation highlighted in the statement is the incorporation of expected treatment benefit into clinical decision-making. Rather than considering only the probability of disease occurrence, clinicians are encouraged to combine predicted risk with the anticipated effectiveness of available therapies to estimate the absolute reduction in risk that an individual patient may achieve through treatment. This personalized approach is expected to support more informed decisions regarding the initiation and intensification of therapies such as antihypertensive agents, lipid-lowering medications, glucose-lowering drugs, and newer cardioprotective treatments for obesity and chronic kidney disease.
The statement also recommends using outcome-specific risk thresholds to stage CKM syndrome, identify subclinical cardiovascular disease, and determine the optimal timing for preventive interventions. By identifying high-risk individuals before significant organ damage occurs, clinicians may be able to intervene earlier, delay disease progression, and reduce the risk of complications such as myocardial infarction, stroke, heart failure, and advanced chronic kidney disease.
The authors further emphasize that individualized risk estimates should serve as the basis for shared decision-making between clinicians and patients. Communicating both disease risk and the expected benefits of treatment can improve patient understanding, encourage informed discussions about preventive therapies, and promote long-term adherence to medications and lifestyle modifications.
Despite significant advances in preventive medicine, many eligible patients remain untreated or undertreated because of limited awareness, inadequate communication of cardiovascular risk, and challenges in implementing evidence-based recommendations. The scientific statement provides practical guidance for integrating comprehensive risk assessment into routine clinical practice and improving discussions that facilitate appropriate treatment decisions.
Public health experts believe that widespread adoption of the PREVENT-based framework could substantially reduce the burden of cardiovascular disease, heart failure, chronic kidney disease, obesity, and diabetes, which collectively account for a large proportion of global morbidity and mortality. By integrating cardiovascular, kidney, and metabolic health into a unified prevention strategy and supporting individualized treatment decisions, the AHA and ACC’s recommendations represent an important step toward more effective, patient-centered care and healthier aging. As implementation expands, the PREVENT equations are expected to become a cornerstone of modern cardiovascular-kidney-metabolic disease prevention.
Reference
- Khan SS, Lloyd-Jones DM, Allen NB, Arnett DK, Blaha MJ, Cushman M, et al. Use of predicted risk and expected benefit to guide decision-making in cardiovascular-kidney-metabolic syndrome for the primary prevention of cardiovascular disease: A scientific statement from the American Heart Association and American College of Cardiology. Circulation [Internet]. 2026 [cited 2026 Jun 26]. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001447