2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome
The first guideline of its kind: obesity, type 2 diabetes, chronic kidney disease and cardiovascular disease are handled as one syndrome staged from 0 to 4, and the document retires and absorbs the 2013 AHA/ACC/TOS obesity guideline. There is no European equivalent — the ESC distributes this territory across its 2023 diabetes, 2021 prevention and (with the kidney societies) KDIGO documents — so the CKM guideline is less a divergence from the ESC than a structural reorganisation of the same evidence, with obesity itself, and incretin-based therapy for it, moved from the margins to the centre. Cardioprotective and kidney-protective drug classes are recommended by CKM stage rather than by the specialty that happens to own the patient. The register's cardiometabolic, kidney and heart-failure trials are grouped below.
This guideline cites 17 of the 199 landmark trials in our Cardiology register.
Obesity & incretin-based therapy7
- 2025SURMOUNT-5Cardiology · Cardiometabolic · GIP/GLP-1 RAA Study of Tirzepatide Compared With Semaglutide in Participants With Obesity or Overweight
- 2025SUMMITCardiology · Cardiometabolic · Obesity & HFpEFTirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity
- 2025SOULCardiology · Cardiometabolic · oral GLP-1 RAA Heart Disease Study of Semaglutide in Patients with Type 2 Diabetes (Semaglutide cardiOvascular oUtcomes triaL)
- 2023SELECTCardiology · Cardiometabolic · GLP-1 RASemaglutide and Cardiovascular Outcomes in Obesity without Diabetes
- 2023STEP-HFpEFCardiology · HF · GLP-1 RASemaglutide Treatment Effect in People with obesity and HFpEF
- 2021STEP 1Endocrinology · Obesity · Semaglutide for obesityOnce-Weekly Semaglutide in Adults with Overweight or Obesity
- 2016LEADERCardiology · Cardiometabolic · GLP-1 RALiraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results
SGLT2 inhibitors — cardiovascular outcomes2
- 2019DECLARE-TIMI 58Cardiology · Cardiometabolic · SGLT2 inhibitorsDapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes
- 2015EMPA-REG OUTCOMECardiology · Cardiometabolic · SGLT2 inhibitorsEmpagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes
Kidney protection3
- 2024FLOWNephrology · CKD · GLP-1 RASemaglutide and Kidney Outcomes in Type 2 Diabetes with Chronic Kidney Disease
- 2020DAPA-CKDNephrology · CKD · SGLT2 inhibitorsDapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease
- 2019CREDENCENephrology · CKD · SGLT2 inhibitorsCanagliflozin and Renal Events in Diabetes with Established Nephropathy
Heart failure across the CKM spectrum5
- 2024FINEARTS-HFCardiology · HF · MRAFinerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction
- 2022DELIVERCardiology · HF · SGLT2 inhibitorsDapagliflozin Evaluation to Improve the Lives of Patients with Preserved-EF Heart Failure
- 2021EMPEROR-PreservedCardiology · HF · SGLT2 inhibitorsEmpagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved EF
- 2020EMPEROR-ReducedCardiology · HF · SGLT2 inhibitorsEmpagliflozin Outcome Trial in Chronic Heart Failure With Reduced EF
- 2019DAPA-HFCardiology · HF · SGLT2 inhibitorsDapagliflozin and Prevention of Adverse outcomes in Heart Failure