Type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease (CVD) are highly prevalent throughout the global population, and pharmacists, as medication and care experts, are often at the front lines. There have been significant advancements in treatment options and strategies for patients with these conditions, yet the shared pathophysiology between cardiovascular, kidney, and metabolic (CKM) syndromes presents a major opportunity for pharmacists to vastly improve care and prevent adverse cardiovascular events.¹

Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS-AQ Cardiology, CACP, a cardiovascular clinical pharmacist and vice president of operations at Baptist Health Paducah, highlighted the unique value of the pharmacist in driving patient education and multidisciplinary collaboration to tackle interconnected CKM conditions. In his presentation at the American Pharmacists Association 2026 Annual Meeting & Exposition in Los Angeles, California, Beavers outlined key evidence-based guidance and educational points for pharmacists to enhance care for patients with CKM.²

“How do we better suit our patients and break down those silos?” Beavers asked during the presentation.²

A Paradigm Shift: Recognizing CKM as an Interconnected Syndrome

Beavers began his presentation by recognizing the new paradigm in CKM care, with a goal of cross-specialty care defragmentation to better recognize the intertwined nature of the conditions. He noted a recent American Heart Association (AHA) Presidential Advisory, released in 2023, that officially defined CKM syndrome and recognized it as a major determinant of premature mortality and multiorgan dysfunction. Importantly, Beavers explained that treating each condition in a silo can fail to address cross-system burden and injury.¹

The Presidential Advisory emphasized pathophysiologic interplay among the 3 conditions, forming a mechanistic triad of risk. Adipose visceral inflammation and microvascular injury, compounded by shared biomarkers of oxidative stress, fibrosis, and mitochondrial dysfunction, amplify risk. Therefore, CVD is associated with kidney disease and T2D, while metabolic dysfunction can lead to adverse cardiac events and CKD, and so on.^1,3

In this setting, the staging system recommended by the AHA Presidential Advisory is critical for pharmacists to note. The spectrum begins at stage 0, considered optimal health, progressing through excess/dysfunctional adiposity (stage 1), metabolic risk factors plus grade 1 through 3 CKD (stage 2), subclinical CVD (stage 3), and clinical CVD plus kidney failure (stage 4). The Presidential Advisory also highlights a new risk calculator called PREVENT (Predicting Risk of Cardiovascular Disease Events), which is recommended over traditional risk scores, which can underpredict risk by 2 to 3 times in patients with CKM. The new risk calculator also allows for longer risk prediction, potentially catching the development of CKM before it progresses further. Knowing the proper CKM stages and tools to risk stratify patients before CKM develops into a serious health risk is a critical pharmacist responsibility. ^1,4

Pharmacists are increasingly recognized as high-impact clinicians in the CKM space, largely because they are at the intersection of medication management, patient education, and care coordination. Patients with CKM share a pathophysiology, and biomarkers such as estimated glomerular filtration rate (eGFR), potassium, blood pressure, hemoglobin A_1c, and urine albumin to creatinine ratio indicate risk of adverse outcomes across conditions. Pharmacists can incorporate routine, broad screening of these factors as a critical component of ongoing patient care, according to Beavers.¹

Pharmacology Pillars for CKM Syndrome

Given the shared mechanisms behind CVD, metabolic disease, and CKD, primary and secondary prevention must encompass multiple strategies at once, according to Beavers. Pharmacists and health care professionals should emphasize lifestyle and behavioral strategies, blood pressure control, metabolic/glycemic modulation, lipid/atherogenic risk reduction, and anti-inflammatory or antifibrotic therapies. Critically, the order and combination of treatment strategies depend on both the CKM stage and the individual phenotype, as well as patient preference and tolerability.¹

The metabolic axis presents avenues for risk reduction and progression prevention. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent cornerstone agents for patients with CKM. In data from trials including DAPA-CKD (NCT03036150) and EMPA-KIDNEY (NCT03594110), SGLT2i led to significant relative risk reductions in CKD progression or cardiovascular death in diabetic and nondiabetic CKD. Meanwhile, GLP-1 RAs in patients with or without T2D have been found to reduce the risk of major adverse cardiovascular events, lower lipid levels, and reduce inflammation.^5-7

For CKD or CVD, Beavers outlined further pharmacologic steps for CKM prevention. SGLT2i again play a role, but Beavers noted that renin-angiotensin-aldosterone system (RAAS) inhibition “of course, remains foundational.” On the lipid and atherogenic front, new AHA and American College of Cardiology dyslipidemia guidelines recommend statins as a front-line therapy for patients with CKM, with low-density lipoprotein cholesterol reduction a critical marker of risk reduction. If necessary, pharmacists can add additional therapies to statin treatment, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.⁸

Ultimately, pharmacotherapy isn’t always enough. Beavers explained that, before initiating agents to treat CKM, patients—buoyed by pharmacist counseling—should promote disease prevention by improving lifestyle factors. These include eating healthy and nutritious foods, staying active, quitting smoking, managing weight and blood pressure, and getting healthy sleep. Beavers highlights that promoting lifestyle changes spans all stages of CKM, while addressing disparities in care, and should be a foundation of care in CKM.

“Pharmacotherapy is very important, but we still have to address the lifestyle and behavioral axes,” Beavers cautioned. “As you’re going across these stages, you’re still doing lifestyle changes and addressing social determinants of health (SDOH).”²

Where Pharmacists Can Improve Outcomes

Pharmacists can address critical, specific gaps in the prevention and management of CKM syndrome. In their role as members of an interdisciplinary care team, Beavers notes that pharmacists can act as “CKM coordinators” across interprovider communication and patient navigation. Beavers emphasized team-based care as especially beneficial, improving population health, professional satisfaction, and patient experiences while lowering overall health care costs.⁹

Going into detail, Beavers outlined specific ways that pharmacists can play a role in CKM care. Through providing patient-specific services (assessing SDOH, drug interaction screening, and patient education), facility-specific services (formulary management, quality improvement initiatives), and global services (legal consultations, public health initiatives, policy development), pharmacists—no matter their role—can contribute to improved patient outcomes.¹⁰

Beyond direct clinical integration, pharmacists are key resources for ensuring medication access and assisting with patient financial constraints. By offering prior authorization support, patient assistance programs, and comprehensive medication management, pharmacists can ensure patients not only know about their available treatment options but also actively adhere to and are involved in personalized care.¹¹

“We’ve been doing a lot of these things for a while. It’s just a repackaging and getting everyone to talk on the same page of these processes,” Beavers explained. “It doesn’t matter what setting we’re in; we all need to stay aware and engaged and figure out…how we can be in partnership and help break [these silos] down.”²

With new CKM guidelines set to be released within the next few months, recognition of this interconnected syndrome among pharmacists and health care professionals should continue to heighten.

REFERENCES

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2. Beavers C. “MetaboLINK: connecting the dots in cardio-kidney-metabolic care.” Presented at: American Pharmacists Association 2026 Annual Meeting & Exposition; March 27-30, 2026; Los Angeles, CA.

3. Mark PB, Carrero JJ, Matsushita K, et al. Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study. Eur Heart J. 2023;44(13):1157-1166. doi:10.1093/eurheartj/ehac825

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8. Writing Committee Members; Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. Published online March 13, 2026. Accessed March 27, 2026. doi:10.1161/CIR.0000000000001423

9. Brush JE Jr, Handberg EM, Biga C, et al. 2015 ACC health policy statement on cardiovascular team-based care and the role of advanced practice providers. J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550

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