Cardiovascular-kidney-metabolic syndrome and treatment advances: a narrative review.

The American Heart Association has reformulated the chronic cardiorenal syndromes into the cardiovascular-kidney-metabolic syndrome. This formulation emphasizes the importance of adipose tissue as the key element in the development of chronic diseases, including diabetes, cardiac disease, and renal disease. The pathogenesis involves multidirectional pathways which have adverse effects on the vascular system, the heart, and the kidneys. Important outcomes in these patients include coronary disease, chronic heart failure, diabetes, and renal failure. The development of new drugs, including SGLT2 inhibitors, GLP-1 agonists, and mineralocorticoid receptor blockers have provided important advances in the treatment of these patients, and multiple randomized controlled trials have reported reductions in adverse cardiac and renal outcomes. This review summarizes the clinical trials with these drugs and provides a brief discussion of their pharmacology.