Cardiovascular–kidney–metabolic syndrome: conceptual framework, clinical implications, and therapeutic perspectives with a focus on SGLT2 inhibitors

The increasing prevalence and frequent coexistence of cardiovascular, renal, and metabolic diseases represent a major challenge to contemporary preventive cardiology, substantially contributing to adverse clinical outcomes and premature cardiovascular mortality. In response to this growing burden, a recent presidential scientific statement from the American Heart Association introduced the concept of cardiovascular–kidney–metabolic (CKM) syndrome as an integrated clinical construct that captures the complex and bidirectional interactions among these conditions, with a primary focus on cardiovascular risk stratification and mortality prevention. This review summarises and critically evaluates the conceptual foundations, clinical implications, and therapeutic considerations of CKM syndrome from a national and multidisciplinary perspective, with particular emphasis on the positioning of sodium–glucose cotransporter-2 inhibitors (SGLT2i) across the CKM continuum. The introduction of the CKM framework is particularly timely in the era of disease-modifying therapies with proven cardiorenal protective effects, notably sodium–glucose cotransporter-2 inhibitors (SGLT2i). However, the real-world implementation of the proposed CKM definition and staging system may be influenced by regional epidemiology, healthcare structures, and patterns of comorbidity. Given the high and rising prevalence of cardiometabolic risk factors, chronic kidney disease, and cardiovascular mortality in Türkiye, a critical appraisal of the CKM syndrome from a national and multidisciplinary perspective is warranted. Practical challenges and opportunities related to patient identification, risk stratification, and integrated management strategies in routine clinical practice are discussed, with the aim of informing preventive cardiology approaches and guiding future research priorities within and beyond the Turkish healthcare context.