In an interview with Pharmacy Times, Fátima Rodriguez, MD, MPH, FAHA, FACC, vice chair of the American Heart Association (AHA)/American College of Cardiology (ACC) cardiovascular-kidney-metabolic (CKM) syndrome guideline writing committee and an associate professor of cardiovascular medicine at Stanford Medicine, discussed how the newly published guideline addresses health equity by recommending routine screening for social drivers of health, such as food insecurity and housing instability, at every stage of CKM care.
Rodriguez highlighted the new PREVENT risk equations, which replace the Pooled Cohort Equations with a race-free, sex-specific model that factors in kidney function, hemoglobin A1c, and a 30-year risk horizon for younger adults. She also discussed the role of technology, including artificial intelligence (AI)-assisted screening, electronic health record (EHR)-integrated tools, and telehealth, in expanding equitable access to CKM care, emphasizing that these tools must be intentionally designed and validated across diverse populations. Rodriguez closed by underscoring the critical role pharmacists play in helping patients access and understand the growing number of multisystem therapies now available for cardiovascular, kidney, and metabolic disease.
Pharmacy Times: Can you please introduce yourself?
Fátima Rodriguez, MD, MPH, FAHA, FACC: Hello, my name is Fátima Rodriguez, and I'm a professor of medicine at Stanford University and the chief of preventive cardiology here. I also was honored to serve as vice chair of the cardio-kidney-metabolic (CKM) syndrome guidelines that were just published.
Key Takeaways
- Pharmacists should help integrate routine screening for social drivers of health, like food insecurity and housing instability, since the guideline recommends this at every CKM stage.
- The new PREVENT risk equations remove race as a variable and add kidney function, hemoglobin A1c, and a 30-year risk window, giving pharmacists a sharper tool for counseling on long-term cardiometabolic risk.
- With multisystem therapies now available for CKM syndrome, pharmacists play a critical role in closing access and adherence gaps for patients across cardiovascular, kidney, and metabolic disease.
Pharmacy Times: How disproportionately does CKM syndrome fall on historically marginalized communities, and does this guideline do enough to address that inequity head-on?
Rodriguez: Thank you for that question. This guideline explicitly focuses on addressing health disparities and health inequities as part of how you assess and define CKM categories. We know that historically marginalized populations have a disproportionate burden of cardiometabolic risk factors, but often those are diagnosed later, when they've progressed to higher stages. What we hope to do in this guideline is, again, to start early and really focus upstream on the social drivers of health so that people don't progress as frequently to the higher CKM stages.
Pharmacy Times: The guideline recommends screening for social drivers of health, food insecurity, housing instability, and financial strain at every stage of CKM care. What does actually collecting and acting on that information look like in practice, and what's the biggest barrier to making it routine?
Rodriguez: We explicitly have recommendations on routinely screening for adverse social drivers of health that can impact how individuals experience cardiometabolic disease. We provide details on validated tools and scales that can be used in clinical settings to do this routinely, and when these adverse social determinants of health are identified, we then recommend actually taking action on them and navigating those barriers to help our patients reach their health goals. But routinely, of course, it's challenging to add this to an already busy clinical encounter, and that's something that needs to be intentional. And by making this just part of the clinical conversation encounter, just as we're screening for obesity, it becomes a lot more routine and less of an uncomfortable question for both patients and their clinicians.
Pharmacy Times: The guideline endorses the new PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations for 10- and 30-year CVD (cardiovascular disease) risk estimation, which now factor in kidney and metabolic health. Do these new equations close the gap meaningfully for diverse patients, and where do you see room for further refinement?
Rodriguez: The PREVENT equations really are an enhancement from our prior way that we assess risk, which were the Pooled Cohort Equations. These are specifically race-free equations. They're sex-specific, but they contain, as you mentioned, other factors that were not part of our prior risk prediction equations, including hemoglobin A1c, kidney function, and an optional social deprivation index. I think there is some enhancement in that we removed race as a proxy of a lot of the social determinants of health and now more explicitly focus on the risk factors, or cardiometabolic risk factors. The other enhancement of these guidelines is that, instead of just focusing on a 10-year horizon, we know that patients obviously experience risk over time, so now, for younger adults, we can start early and really think about a 30-year horizon for risk. Additionally, there's a focus on total cardiovascular disease burden, not just on ASCVD (atherosclerotic cardiovascular disease), even though there are separate equations for ASCVD and heart failure, because again, we know the risk can vary.
Pharmacy Times: As clinicians and health systems try to implement this guideline at scale, where does technology, whether AI-assisted screening, EHR-integrated risk tools, or telehealth, fit into making CKM care more equitable and accessible?
Rodriguez: This is a topic near and dear to my heart, since I'm here in Silicon Valley, where we see the tremendous power and opportunities that technology can give us, but it has to be intentional. One really valuable tool that we can have with technology is that it can help us screen opportunistically for disease. I've done a lot of work looking at opportunistic screening with artificial intelligence for atherosclerotic disease, and that can really help us identify people who may not come to care specifically seeking preventive interventions. You mentioned telehealth—telehealth is also valuable, really, to extend reach, and we actually have some recommendations in the guideline; specifically, if you can have face-to-face conversations, it's really valuable to use digital health apps and interventions, particularly around weight loss and cardiometabolic prevention. But I think you really need to be intentional in the design of the technology, make sure you're validating the performance across subgroups, and monitor carefully that the intended intervention really functions well across all populations.
Pharmacy Times: Is there anything else that you would like to add, or anything that I missed?
Rodriguez: I think the other really important point for our pharmacy colleagues is that we now have these tremendous medications that can have multisystem benefits, not just for CVD, but also for diabetes and kidney disease. It is very important that these interventions work for everybody, and there are, of course, a lot of issues around access and understanding indications. I think our pharmacy colleagues really play such a major role in helping close these gaps when we have evidence for therapies that work well.
