Treatment of Cardiometabolic Risk Factors in Adults with Cardiovascular-Kidney-Metabolic Syndrome: A Narrative Review of Evidence-Based and Real-World Observational Data: A Clinical Review for Practising Physicians

Dr. Ranjit Gain, Dr. Priya Mondal

Abstract: Background: Cardiovascular-kidney-metabolic (CKM) syndrome describes the mechanistic and clinical overlap between excess or dysfunctional adiposity, metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). The American Heart Association formally defined and staged it (Stage 0 through Stage 4) in 2023,?,? and the AHA, American College of Cardiology (ACC), American Diabetes Association (ADA), and American Society of Nephrology (ASN) translated that framework into a full multi-society clinical practice guideline in 2026.? Objective: To synthesise published epidemiological, randomised-trial, and real-world observational evidence on the treatment of cardiometabolic risk factors in adults with CKM syndrome - with attention to data relevant to Indian clinical practice - and to summarise the safety and tolerability profile of guideline-recommended agents alongside their efficacy. Evidence synthesis: Large population cohorts confirm a graded, accelerating rise in all-cause and cardiovascular mortality across CKM stages, while nationally representative Indian data (ICMR-INDIAB) document a very high underlying burden of the component risk factors. Contemporary trial evidence supports a foundational, risk-based treatment architecture built on lifestyle and weight management, cardioprotective antihyperglycaemic therapy (SGLT2 inhibitors and GLP-1-based therapies), renin-angiotensin-system (RAS) blockade with a non-steroidal mineralocorticoid receptor antagonist for albuminuric CKD, and aggressive lipid and blood-pressure control. Each pillar carries a distinct safety signal - GI intolerance with GLP-1-based agents, genital mycotic infection and rare euglycaemic ketoacidosis with SGLT2 inhibitors, hyperkalaemia with finerenone - that is clinically manageable but needs active monitoring, not passive prescribing. Observational findings: Indian real-world data repeatedly document a wide gap between guideline recommendation and everyday prescribing - statin and antiplatelet use below 2% in individuals with a major cardiovascular risk factor, and LDLcholesterol goal attainment in only about one in four patients with established coronary disease, despite statin therapy. Conclusion: Closing the treatment-implementation gap, not generating further efficacy data, is the principal unmet need in CKM care in India.

Keywords: cardiovascular-kidney-metabolic syndrome, cardiometabolic risk, SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, chronic kidney disease, dyslipidaemia, India, treatment gap, safety and tolerability

How to Cite?: Dr. Ranjit Gain, Dr. Priya Mondal, "Treatment of Cardiometabolic Risk Factors in Adults with Cardiovascular-Kidney-Metabolic Syndrome: A Narrative Review of Evidence-Based and Real-World Observational Data: A Clinical Review for Practising Physicians", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 616-623, https://www.ijsr.net/getabstract.php?paperid=SR26809235305, DOI: https://dx.doi.org/10.21275/SR26809235305

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