Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention.

The substantial and growing prevalence of heart failure, which remains the leading cause of preventable hospitalisation worldwide, has brought heart failure prevention into sharp focus. Although this condition has historically been characterised by impaired cardiac function, mounting evidence has underscored its complex and multisystem pathobiology. Epidemiological studies have indicated that other forms of cardiovascular disease, along with kidney and metabolic dysfunction, frequently and increasingly contribute to heart failure onset. Clinical trials have additionally demonstrated the power of several new pharmacotherapies to simultaneously modify cardiovascular, kidney, and metabolic (CKM) health. This convergence of epidemiology and therapy highlights deeply interconnected mechanisms of disease, identifying CKM diseases-and their pathophysiological and sociostructural antecedents-as important but often under-recognised targets for heart failure prevention. Herein, we illustrate that positioning heart failure prevention within the broader context of CKM health provides an actionable framework for patients, health-care professionals, health systems, communities, and policy makers.