Cardiometabolic Inflammation and Early Vascular Dysfunction: Expanding the Frontiers of Cardiovascular Risk Stratification

Cardiovascular disease remains the leading cause of global morbidity and mortality, despite significant advances in lipid management and risk factor control. Emerging evidence indicates that cardiometabolic dysfunction and chronic low-grade inflammation act synergistically to accelerate early vascular injury long before the onset of overt clinical events. This review integrates contemporary epidemiological data, mechanistic insights, biomarker analyses, and randomized clinical trial evidence to examine the cardiometabolic–inflammatory–vascular axis as a unified framework for early cardiovascular risk assessment. Population-level data confirm the sustained global expansion of cardiovascular burden, paralleled by increasing prevalence of metabolic syndrome and insulin resistance. Inflammatory biomarkers such as high-sensitivity C-reactive protein and interleukin-6 demonstrate graded associations with incident cardiovascular events, independent of traditional risk factors. Arterial stiffness emerges as a measurable intermediate phenotype reflecting cumulative metabolic and inflammatory exposure, with higher quartiles associated with substantially increased event rates. Furthermore, randomized trials targeting inflammatory pathways show reductions in major adverse cardiovascular events in selected high-risk populations, supporting inflammation as a modifiable contributor to atherosclerotic progression. The integration of inflammatory biomarkers into traditional prediction models yields modest but consistent improvements in discrimination and risk stratification. These findings collectively support a paradigm shift toward earlier biological detection of vascular dysfunction. Such an approach is particularly relevant for regions experiencing rapid growth in cardiometabolic risk, including Mexico, Colombia, and Ecuador. Advancing cardiovascular prevention will require integrative strategies that combine metabolic control, inflammatory assessment, and early vascular evaluation within a precision-based framework.