U.S. News: Report Urges New Focus on Metabolic Health --- Guidelines are issued to help clinicians prevent and manage CKM syndrome

“Mitzi Franklin was diagnosed with high blood pressure at the age of 16. She didn't take it all that seriously, often skipping her medicine. "I was your typical teenager thinking I was invincible," she said.

 

A decade or so later, Franklin learned she had chronic kidney disease. At 42, she had a heart attack and a stroke, then four open heart surgeries. Then diabetes and congestive heart failure.

 

Franklin, now 54, is one of millions of Americans with cardiovascular-kidney-metabolic syndrome, a disorder defined in 2023 by the American Heart Association. It describes a cluster of conditions -- heart disease, diabetes, kidney disease -- that have common risk factors and fuel one another. Long treated as isolated or individual diseases, the conditions are interrelated, usually tied to excess abdominal fat, and a major driver of heart disease, according to the AHA.

 

On Tuesday, the AHA and three other medical societies published the first guidelines to help clinicians prevent and manage CKM, as it is called, urging them to focus on their patients' overall metabolic health. The goal is to prevent or slow the progression of conditions that may ultimately lead to heart attacks and strokes, which are becoming more common in younger adults.

 

The new guidelines call for doctors to screen patients for metabolic risk factors and kidney function routinely. Risk from excess fat should be measured both by body-mass index and waist circumference, according to the new guidelines, which were developed by the AHA and the American College of Cardiology with the American Diabetes Association and American Society of Nephrology.

 

In the 1970s, smoking, high blood pressure and cholesterol were the classic risk factors for heart disease, said Dr. Chiadi Ndumele, chair of the committee that wrote the new guideline and a preventive cardiologist at Johns Hopkins University School of Medicine.

 

Today, excess abdominal fat is a major risk factor because it can trigger chronic inflammation that damages arteries, cardiac tissue and kidneys, he said.

 

Nearly 90% of Americans meet the criteria for CKM, according to a 2024 study. Most people are in the first two of four stages, with excess body fat and some risk factors such as high blood pressure or cholesterol.

 

Only 9.2% are at the most advanced stage, with heart failure or another diagnosed form of heart disease, along with other metabolic conditions such as kidney disease, according to the study.

 

There are drugs on the market that studies show have benefits for more than one of these conditions at once, such as GLP-1s and a class of drugs known as SGLT inhibitors [1].

 

While these diseases and even some treatments are interrelated, they are often treated as separate conditions with their own specialists. Most people with high blood pressure, diabetes and obesity aren't screened for kidney disease, for example, said Dr. Daniel Weiner, a nephrologist at Tufts Medical Center, who was on a review committee for the guideline.

 

Franklin learned she had kidney disease in her 20s when a new primary-care doctor saw that her blood pressure was chronically high and sent her to a nephrologist. By then, her kidneys had suffered damage.

 

A busy single mom, she focused on her heart in the years between surgeries, exercising and trying to eat right, but didn't always keep up with her nephrologist. Franklin learned a few years ago that her diseases were connected. Now, she said, when she doesn't feel well, she doesn't automatically assume the problem is her heart. She also checks her blood sugar and to see how much water she is drinking.” [2]

 

1. SGLT2 inhibitors (Sodium-Glucose Cotransporter 2 inhibitors) are a class of oral medications that block the reabsorption of glucose in the kidneys, forcing the body to excrete excess sugar through urine. They are primarily prescribed to treat Type 2 diabetes, chronic kidney disease (CKD), and heart failure.

Common Medications

Several SGLT2 inhibitors are FDA-approved, often prescribed under the following brand names:

•           Empagliflozin (Jardiance)

•           Dapagliflozin (Farxiga)

•           Canagliflozin (Invokana)

•           Ertugliflozin (Steglatro)

•           Bexagliflozin (Brenzavvy)

Key Benefits

•           Heart and Kidney Protection: They significantly reduce hospitalization for heart failure and slow the progression of chronic kidney disease.

•           Blood Sugar Control: They lower A1c levels by removing excess glucose directly via the urine.

•           Weight Loss: Because sugar is essentially calories leaving the body, they often lead to mild weight loss.

•           Blood Pressure: They can provide mild reductions in blood pressure.

Potential Side Effects

•           Genital Infections: Due to the high sugar content in urine, urinary tract infections (UTIs) and yeast infections are common.

•           Dehydration: Because they act as a mild diuretic, they can increase urination, leading to dehydration or a drop in blood pressure.

•           Diabetic Ketoacidosis (DKA): Though rare, they can cause a serious condition where ketone levels build up in the blood.

Note: SGLT2 inhibitors are entirely different from GLP-1 receptor agonists (such as Ozempic or Wegovy), which work by mimicking gut hormones to suppress appetite and stimulate insulin production

 

2. U.S. News: Report Urges New Focus on Metabolic Health --- Guidelines are issued to help clinicians prevent and manage CKM syndrome. McKay, Betsy.  Wall Street Journal, Eastern edition; New York, N.Y.. 10 June 2026: A6.