{
  "abstract": "BackgroundThe 2026 cardiovascular-kidney-metabolic (CKM) syndrome guideline broadens recommendations for glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), but the increment over pre-2026 standards is unknown. We estimated the number and clinical profile of US adults newly eligible under this guideline.\n\nMethodsCross-sectional analysis of adults aged 30-79 years in the 2011-2018 National Health and Nutrition Examination Survey. Adults were newly eligible if they met 2026 CKM guideline indications but not pre-2026 American Diabetes Association, American College of Cardiology/American Heart Association heart failure, Kidney Disease: Improving Global Outcomes, or obesity guideline indications. Sensitivity analyses used 2 US Food and Drug Administration (FDA) label standards.\n\nResultsAmong 175.17 million US adults, 111.84 million (63.8%) were already eligible for either class. The CKM guideline added 7.48 million (95% CI: 6.48 to 8.47), a 6.7% increase, all for GLP-1RA and none for SGLT2i: 6.49 million with overweight (body mass index 27.0-29.9 kg/m2, ethnicity adjusted) and no other cardiometabolic disease, and 0.99 million with type 2 diabetes and 10-year PREVENT cardiovascular risk [≥]7.5%. Newly eligible adults (86.8% CKM stage 1) were younger (46.2 vs 52.9 years), leaner (27.8 vs 33.0 kg/m2), and at lower 10- and 30-year PREVENT risk (3.6% vs 8.1%; 11.3% vs 19.6%; all P < 0.001). Against FDA labeling, 14.15-25.17 million were newly eligible (7.66-18.20 million for SGLT2i). Assuming a 20% relative risk reduction, the projected number needed to treat per cardiovascular event prevented was 243 over 10 years and 56 over 30 years (ages 30-59) in adults with overweight, versus 61 and 26 in already eligible adults.\n\nConclusionsRelative to pre-2026 society guidelines, the 2026 CKM guideline newly confers a GLP-1RA indication on 7.48 million US adults, predominantly at lower cardiovascular risk. Whether treating these adults improves outcomes in a cost-efficient manner remains to be established.\n\nWhat Is KnownO_LIThe 2026 AHA/ACC/ADA/ASN cardiovascular-kidney-metabolic (CKM) syndrome guideline recommends GLP-1 receptor agonists and SGLT2 inhibitors according to CKM stage, comorbidity, and PREVENT-predicted risk, including a GLP-1 receptor agonist for adults with overweight at CKM stage 1. C_LIO_LINational estimates of eligibility for these agents predate the guideline and have largely used FDA labeling, rather than professional society guidance, as the reference standard. C_LI\n\nWhat the Study AddsO_LIRelative to pre-2026 society guidance, the guideline newly identifies 7.48 million US adults aged 30 to 79 years as treatment candidates, all for a GLP-1 receptor agonist and none for an SGLT2 inhibitor; most have overweight without other cardiometabolic disease. C_LIO_LINewly eligible adults are younger and at lower predicted cardiovascular risk than those already eligible; the projected number needed to treat is 243 over 10 years and 56 over 30 years, so expected benefit rests on a lifetime horizon that outcome trials and cost-effectiveness analyses have not yet tested. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Robert Wood Johnson University Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "D. R. Corsi"
    },
    {
      "name": "C. Wang"
    },
    {
      "name": "Y. M. Kang"
    },
    {
      "name": "A. Zimerman"
    },
    {
      "name": "A. O. Agbaje"
    },
    {
      "name": "F. Moura"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b01r61734yvmw.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.22.26366274",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366274v1.full",
  "id": "b01r61734yvmw",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366274v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ],
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
  ],
  "openalex": "W7223704438",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366274v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-22",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/b01r61734yvmw.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:46Z",
      "native_id": "10.64898/2026.10.22.26366274",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366274v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Implications of the 2026 Cardiovascular-Kidney-Metabolic Syndrome Guideline for GLP-1 Receptor Agonist and SGLT2 Inhibitor Eligibility Among US Adults",
  "title_text": "Implications of the 2026 Cardiovascular-Kidney-Metabolic Syndrome Guideline for GLP-1 Receptor Agonist and SGLT2 Inhibitor Eligibility Among US Adults",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:46Z",
  "url": "https://research.draconitic.com/paper/b01r61734yvmw",
  "venue": "medRxiv",
  "versions": []
}