With the rising prevalence of obesity and associated cardiovascular-kidney-metabolic (CKM) syndrome, indications for novel therapies are expanding. A new study has quantified the proportion of US adults who meet the approved indications for three key classes of CKM medications, revealing a substantial number are eligible for treatment.¹
Methodology
This cross-sectional study analysed data from several large US samples to determine eligibility for glucagonlike peptide 1 receptor agonists (GLP-1RAs), sodium-glucose cotransporter-2 inhibitors (SGLT2is), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) based on US Food and Drug Administration (FDA) indications.¹
The analysis included a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES), corresponding to a weighted 245 million adults. It also incorporated data from five pooled community-based cohorts (n=30,929), including the Framingham Heart Study and the Atherosclerosis Risk in Communities Study, and two large ambulatory healthcare samples from Beth Israel Deaconess Medical Center (n=84,714) and Mass General Brigham (n=362,485).
Results
The proportion of individuals meeting current FDA-approved indications for one or more CKM medication was 60% in the NHANES sample (representing 148 million US adults) and 61% in the pooled community cohorts.¹
Eligibility was most common for GLP-1RA therapy, with 56% of the NHANES population (representing 137.1 million adults) meeting the criteria. This was followed by SGLT2i therapy, for which 24% (57.9 million adults) were eligible, and nsMRA therapy, with 5% (11.7 million adults) eligible.
Overlapping eligibility for multiple drug classes was common. Between 12% and 17% of individuals across the cohorts were eligible for both GLP-1RA and SGLT2i therapies. Furthermore, between 1% and 5% of adults met the criteria for all three medication classes, which represents an estimated 11.7 million US adults based on the NHANES data.
In Practice
These findings underscore the significant public health burden of CKM syndrome, a condition that links cardiovascular disease, kidney disease, type 2 diabetes, and obesity.² The study highlights that a large segment of the adult population could potentially benefit from these novel therapies. The authors concluded that their findings suggest “the potential for substantial gains in CKM-related health with greater uptake of these therapies,” and highlight “the urgent need to optimize implementation and utilization of CKM syndrome therapies.”¹
References
1. Mounsey LA, Chitsazan M, Shi I, et al. Cardiovascular-Kidney-Metabolic Medication Eligibility Across National Survey, Community-Based, and Ambulatory Healthcare Samples. JAMA Cardiol. 2026. https://doi.org/10.1001/jamacardio.2025.5305
2. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(20):1606–35. https://doi.org/10.1161/CIR.0000000000001184
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