Evolving Role of Primary Care in Cardiovascular–Kidney–Metabolic Medicine: An Apolipoprotein B–Centered Mechanistic Framework for Cardiometabolic Trajectories

Cardiovascular-kidney-metabolic (CKM) disease has emerged as a dominant driver of global morbidity and mortality, reflecting the convergence of obesity, insulin resistance, dyslipidemia, hypertension, chronic kidney disease, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease (CVD).Traditional care models, organized around single organs, discrete diagnostic thresholds, or episodic clinical events, have proven insufficient to prevent the cumulative progression of CKM disease across the life course.In response, the American Heart Association has proposed CKM syndrome as a unifying framework that emphasizes early detection, staging, and continuity of care.This review argues that CKM medicine is not a new subspecialty but rather an evolution of primary care toward integrated cardiometabolic management.It is proposed that apolipoprotein B (apoB)-centered lipidology provides a mechanistic backbone for CKM medicine by linking metabolic dysfunction to atherosclerotic CVD through cumulative lifetime exposure to atherogenic lipoproteins along CKM disease trajectories.Key pathophysiologic mechanisms, including apoB particle retention, chronic low-grade inflammation, maladaptive interorgan signaling, and metabolic and structural remodeling, are examined.The therapeutic convergence of lipid-lowering, glucose-modifying, and weight-reducing agents acting on shared disease-modifying pathways is further analyzed.Finally, the persistent gap between evidence and real-world implementation is addressed, and a practical framework for integrated cardiometabolic care in primary care settings is outlined.By reframing prevention as long-term modification of cardiometabolic trajectories rather than episodic risk control, primary care can assume a pivotal coordinating role in CKM medicine.