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Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention

John W Ostrominski1, Alice Y Y Cheng2, Adam J Nelson3

  • 1Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Lancet (London, England)
|September 1, 2025
PubMed

Insights

Heart failure prevention is crucial due to rising hospitalizations. Focusing on cardiovascular, kidney, and metabolic health offers a new framework for prevention strategies.

Area of Science:

  • Cardiology
  • Nephrology
  • Metabolic Medicine

Background:

  • Heart failure is a leading cause of preventable hospitalizations globally.
  • Historically viewed as solely a cardiac issue, heart failure is now understood to have complex, multisystem origins.
  • Cardiovascular, kidney, and metabolic diseases frequently precede and contribute to heart failure development.

Purpose of the Study:

  • To highlight the interconnectedness of cardiovascular, kidney, and metabolic (CKM) diseases in heart failure pathogenesis.
  • To propose an actionable framework for heart failure prevention by integrating CKM health.
  • To underscore the importance of addressing pathophysiological and sociostructural factors contributing to CKM diseases.

Main Methods:

  • Review of epidemiological studies on heart failure risk factors.
  • Analysis of clinical trial data on pharmacotherapies affecting CKM health.
  • Synthesis of evidence linking CKM diseases to heart failure onset and progression.

Main Results:

  • Epidemiological data confirm frequent co-occurrence of cardiovascular, kidney, and metabolic dysfunction in heart failure.
  • Emerging pharmacotherapies demonstrate efficacy in simultaneously improving CKM health.
  • A convergence of epidemiological and therapeutic evidence points to shared disease mechanisms.

Conclusions:

  • Heart failure prevention requires a broader perspective encompassing cardiovascular, kidney, and metabolic health.
  • CKM diseases and their antecedents are critical, often overlooked targets for heart failure prevention.
  • An integrated CKM health approach provides a practical framework for diverse stakeholders in heart failure prevention.

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