New Advances in Cardiovascular Drugs: In Memory of Professor Akira Endo

Background: Cardiovascular-kidney-metabolic (CKM) syndrome encompasses interconnected cardiovascular, renal, and metabolic disorders that contribute significantly to global morbidity and mortality. This review aims to synthesize current therapeutic strategies and evaluate emerging treatments that address the multifactorial pathophysiology of CKM syndrome, with a focus on novel pharmacological targets and the role of artificial intelligence (AI) in personalized care. Methods: A comprehensive narrative literature review was conducted using PubMed, Scopus, and Google Scholar. Studies were selected based on relevance to CKM syndrome’s pathophysiology, diagnostic criteria, and treatment modalities, including trials on SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, and RNA-based therapies. The review also included analysis of clinical trials investigating agents targeting lipoprotein(a), MASLD, and inflammatory pathways. Inclusion and exclusion criteria ensured focus on CKM-relevant mechanisms and therapeutic outcomes. Results: SGLT2 inhibitors and GLP-1 receptor agonists demonstrated consistent efficacy in reducing major adverse cardiovascular events, improving renal outcomes, and aiding in glycemic and weight control. Finerenone showed benefit in CKD patients with type 2 diabetes, particularly in reducing inflammation and fibrosis. Emerging therapies—including RNA-based agents, TRβ agonists, and immunomodulators—offer promise in targeting specific metabolic and inflammatory pathways. AI applications were found useful in enhancing CKM risk stratification, biomarker integration, and clinical decision-making. Conclusions: Therapeutic strategies for CKM syndrome have evolved with evidence-based support for integrated pharmacologic and technological interventions. Continued research on precision medicine, guided by AI and novel biomarkers, holds potential to further optimize CKM management and patient outcomes.