IPM Take
CKM syndrome is supposed to end the fiction that obesity, diabetes, kidney disease, hypertension and cardiovascular disease can be managed in separate silos. But the latest data show a brutal implementation gap: even when effective treatments exist, patients are not consistently diagnosed, treated or controlled. The next frontier in cardiometabolic care is not only new drugs. It is delivery: screening, titration, affordability, community outreach, data systems and accountability. Guidelines do not execute themselves.
Executive Summary
A new JACC study examined treatment and control of hypertension, diabetes and hyperlipidaemia among US adults with cardiovascular-kidney-metabolic (CKM) syndrome stage 2 or above, using National Health and Nutrition Examination Survey data from 2015 to 2023.
The findings show major gaps across the cardiometabolic care cascade. Only 51% of adults with hypertension and 49% of those with hyperlipidaemia were receiving treatment. Among those treated, only 45% achieved blood pressure control and 47% achieved glycaemic control, while cholesterol control was higher at 68%.
The gaps were not evenly distributed. Younger adults aged 20-44 had the lowest treatment rates for hypertension, diabetes and hyperlipidaemia. Women were less likely than men to receive treatment for diabetes and hyperlipidaemia, and Hispanic adults had the lowest treatment rates for hypertension and hyperlipidaemia among racial and ethnic groups.
The timing matters. In June 2026, the AHA, ACC, ADA and ASN released the first-ever clinical practice guideline for CKM syndrome, aiming to unify prevention, detection, evaluation and management across cardiovascular, kidney and metabolic disease. But the JACC data expose the central problem: the CKM framework identifies who needs care, while the system still fails to deliver that care reliably.
Why it matters
- Policymakers and public authorities: CKM care requires implementation policy, not just guideline publication. Screening, treatment intensification, medicines access and community follow-up need to become measurable health-system priorities.
- Payers: Coverage barriers and out-of-pocket costs are limiting uptake of cardioprotective and nephroprotective medicines, including SGLT2 inhibitors and GLP-1 receptor agonists. Access policy is now cardiovascular prevention policy.
- Clinicians and providers: The major gap is no longer only treatment initiation. It is control: therapy titration, reaching blood pressure and HbA1c targets, and using risk to guide treatment intensity.
- Hospitals and health systems: CKM care needs population dashboards, EHR prompts, remote monitoring, pharmacist-supported medication management, community health workers and closed-loop follow-up.
- Patients and advocates: Younger adults, women, Hispanic patients and people with poor access to care are falling through the cracks. CKM cannot become another framework that works best for those already closest to the system.
Cardiometabolic medicine is having a framework moment.
Cardiovascular-kidney-metabolic syndrome, or CKM, is now the language of the field. The idea is right: heart disease, kidney disease, diabetes, obesity, hypertension and abnormal lipids do not occur in isolation. They reinforce each other. They should be detected, staged and treated together.
But a new JACC study shows the uncomfortable truth. Naming the problem does not fix the care cascade.
The study analysed 6,384 US adults aged 20 years and older with CKM stage 2 or above, using NHANES data from 2015 to 2023. It found that treatment for common, treatable cardiometabolic risk factors remains far too low. Only 51% of adults with hypertension and 49% of adults with hyperlipidaemia were receiving treatment. Among those treated, fewer than half achieved blood pressure or glycaemic control.
That is the scandal inside the CKM revolution.
These are not obscure diseases. Hypertension, diabetes and hyperlipidaemia are among the most familiar risk factors in medicine. The drugs exist. The guidelines exist. The evidence exists. Yet the system still fails to move enough patients from risk recognition to treatment, and from treatment to control.
The failure is sharper among those who should be reached early. Younger adults aged 20-44 had the lowest treatment rates: 28% for hypertension, 74% for diabetes and 20% for hyperlipidaemia. That should alarm every policymaker. Cardiometabolic risk carried in the 20s and 30s does not disappear. It accumulates quietly until it becomes heart failure, kidney disease, stroke, myocardial infarction or early mortality.
The study also found inequities by sex and ethnicity. Women were less likely than men to receive treatment for diabetes and hyperlipidaemia. Hispanic adults were the least likely racial or ethnic group to receive treatment for hypertension and hyperlipidaemia. This is not just a clinical gap. It is a structural one.
The most counterintuitive finding may be the most important: blood pressure control was worse among people with higher cardiovascular risk. In a rational system, the highest-risk patients would receive the most aggressive risk-factor control. In the real system, those most likely to benefit are still not consistently reaching targets.
That is not a knowledge failure. It is implementation failure.
At the 2026 Heart in Diabetes meeting, Rishi Wadhera described the cardiometabolic care cascade as fractured across awareness, treatment and control. In the HCPLive interview, he noted that nearly 40% of US adults aged 20-44 with hypertension are unaware of their diagnosis, and only about one in three adults with diabetes knows they have the condition. He also highlighted that SGLT2 inhibitors and GLP-1 receptor agonists reach only about one in five eligible patients with diabetes, despite their cardioprotective and nephroprotective benefits.
This is where the CKM framework collides with reality.
The first-ever AHA/ACC/ADA/ASN guideline on CKM syndrome, released in June 2026, calls for earlier screening, staging, risk assessment, coordinated interdisciplinary care and the use of therapies such as GLP-1-based treatments and SGLT2 inhibitors for selected patients. It is a major step away from siloed medicine.
But guidelines cannot titrate a blood pressure medicine. They cannot make a GLP-1 affordable. They cannot schedule follow-up. They cannot overcome language barriers. They cannot fix fragmented records between cardiology, primary care, nephrology and endocrinology. They cannot turn a one-off clinic visit into sustained risk control.
That is the policy gap.
The US data are especially relevant because they come from a wealthy health system with advanced therapies, major professional societies and high biomedical spending. If CKM care is failing there, the global implications are even more serious.
WHO estimates that 1.4 billion adults aged 30-79 had hypertension in 2024, and about 600 million were unaware they had the condition. Only around 44% were diagnosed and treated. WHO also reports that 14% of adults aged 18 and older were living with diabetes in 2022, and that 59% of adults aged 30 and over with diabetes were not taking medication for it. These are not marginal numbers. They are the global cardiometabolic care cascade breaking in plain sight.
The solution cannot be a new acronym alone.
CKM care needs delivery infrastructure. That means routine screening for blood pressure, glucose, kidney function and lipids. It means risk-based treatment intensification. It means patient registries and population health dashboards that show who is uncontrolled, not just who showed up. It means pharmacists, nurses and community health workers supporting adherence, titration and follow-up. It means remote monitoring and digital prompts where they improve care, not where they simply generate alerts.
It also means affordability.
The cardiometabolic field now has powerful therapies that protect the heart and kidneys, but access is uneven. Coverage restrictions, prior authorization, high out-of-pocket costs and fragmented prescribing responsibility all limit uptake. A patient with diabetes, CKD and cardiovascular risk should not need to win a bureaucratic lottery to receive evidence-based medicines.
This is where payers become part of the clinical pathway. If they block access to therapies with proven cardiovascular and renal benefit, they are not just managing budgets. They are shaping cardiovascular outcomes.
There is also a workforce issue. CKM syndrome demands coordinated care across specialties, but the patients most at risk often live in systems where specialist access is limited and primary care is overloaded. The guideline’s vision of integrated care will only work if health systems pay for coordination, not just appointments. A “CKM coordination point person”, team-based care, shared protocols and community-based follow-up should not be aspirational language. They should be commissioned services.
For personalised medicine, the lesson is blunt. Risk stratification means little without implementation. It is not enough to know that a patient has CKM stage 2, high 10-year risk, uncontrolled blood pressure and early kidney disease. The system must then do something: intensify treatment, address affordability, support adherence, monitor progress and close the loop.
Otherwise, precision becomes documentation.
The CKM framework is necessary. It tells medicine to stop pretending that organs fail separately. But the JACC study shows that the framework is arriving in a system still designed for episodic, fragmented and inequitable care.
That is the real cardiometabolic challenge of 2026.
The therapies are here. The risk factors are known. The guidelines are published.
The missing intervention is delivery.
