Joint Symposium: AHA/ESC/IDF by Khan S

Khan S, presented a session at IDF World Diabetes Congress 2025 from 7th-10th April 2025 in Bangkok. Globally the cardiometabolic risk is increasing with the rising rates of obesity, hypertension and pre-diabetes and diabetes (Circulation 2024). There is a need for a new prevention paradigm due to the complex interplay between metabolic disease, CKD, and CVD. However, there is hope with advancements in scientific understanding, the emergence of novel therapies, and growing evidence for treatments that impact all three systems simultaneously.

Cardiovascular-kidney-metabolic (CKM) syndrome is a health disorder due to connections among heart disease, kidney disease, diabetes and obesity leading to poor health outcomes. The AHA CKM construct outlines stages 0 to 4, tracking the progression from no risk factors to clinical cardiovascular disease in CKM syndrome. Early stages focus on obesity, glucose intolerance, and metabolic risk factors, while later stages highlight subclinical and clinical CVD, emphasizing the importance of early prevention.

Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. The AHA PREVENT study enrolled >1M male and females in the study. For total CVD, females had a higher predictive accuracy (C-statistic 0.794) compared to males (0.757). Similar trends were observed in ASCVD and HF outcomes, with consistently strong model calibration across sexes. These findings support the reliability of the model in predicting cardiovascular events.

By the comparison of PREVENT and PCEs models for predicting CVD, ASCVD, and HF outcomes, PREVENT showed higher C-statistics and better calibration across both sexes. Notably, PREVENT-ASCVD and PCEs showed a strong correlation of 0.925, indicating consistency between models. In January, the AHA released a PREVENT calculator to predict a person’s odds of developing heart disease. This the updated tool considers broader measures of health and a longer horizon of risk.

SGLT2i, long-acting high-potency GLP-1 RA and non-steroidal MRAs are considered as a significant cardiovascular kidney metabolic therapy.

Conclusion:

The burden of phenotype of CVD is shifting with growing prevalence of the cardiovascular kidney metabolic syndrome. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. PREVENT accurately and precisely predicts risk for CVD, ASCVD and HF, particularly in persons living with diabetes and/or CKD. Future research should focus on global validation and evidence-based implementation of statins and more broadly CKM therapies.