Biomarkers of Immune Injury in Cardiometabolic Disorders

Cardiometabolic disorders are accompanied by persistent immune activation that links metabolic stress to vascular and organ injury. Conventional inflammatory measures capture part of this process, but they provide limited information about tissue origin, biological mechanism and disease trajectory. This narrative review examines emerging biomarkers across genetic and epigenetic regulation, metabolic and oxidative stress, gut microbial exposure, innate immune activation, adaptive immune remodeling and circulating inflammatory responses. It integrates mechanistic studies with clinical observations to consider how these signals may inform the assessment of cardiometabolic immune injury. Particular attention is given to the distinction between inherited susceptibility and acquired responses, circulating associations and tissue mechanisms, and potentially injurious versus compensatory immune activity. The evidence supports substantial biological connectivity among these domains, while the strength of clinical validation varies widely. Most candidate markers and proposed combinations require standardized measurement, longitudinal assessment and external validation before biomarker-guided prevention can be justified. We propose a mechanism-informed framework for organizing candidate immune-metabolic phenotypes, recognizing reciprocal interactions rather than a universal temporal sequence. Future studies should determine whether these biomarkers improve prediction and clinical decisions beyond established risk factors and whether changes in biomarker profiles correspond to meaningful treatment benefits.