Immunometabolic Pathways in Cardiovascular Disease: Inflammation and Metabolic Dysfunction Beyond Traditional Risk Factors

Cardiovascular disease remains the leading cause of mortality worldwide, despite significant advances in prevention and treatment strategies. Increasing evidence indicates that traditional risk factors alone are insufficient to fully explain cardiovascular risk, highlighting the importance of inflammatory and metabolic mechanisms in the development and progression of atherosclerotic disease. This review synthesizes current scientific evidence on the role of chronic low-grade inflammation and metabolic dysregulation as interconnected determinants of cardiovascular risk. The analysis integrates mechanistic, clinical, and population-level data describing how immune activation, insulin resistance, obesity, metabolic syndrome, and endothelial dysfunction interact to promote atherosclerosis and related cardiovascular outcomes. Particular attention is given to inflammatory signaling pathways, immune cell involvement, and the concept of residual inflammatory risk, which persists even in the presence of optimal lipid control. Additionally, the review examines the contribution of lifestyle factors as upstream modulators of immunometabolic processes. By adopting an integrative immunometabolic perspective, this review provides a comprehensive framework for understanding cardiovascular risk beyond conventional models. This approach is especially relevant for educational and clinical contexts in regions undergoing epidemiological transition, including Mexico, Colombia, and Ecuador. The findings support the incorporation of inflammatory and metabolic determinants into cardiovascular risk assessment, prevention strategies, and future research agendas.