Targeting cardiovascular immunometabolism with phytomedicines: an emerging therapeutic technique

Cardiovascular diseases (CVDs) continue to be leading causes of morbidity and death globally, with chronic inflammation contributing to disease progression and residual cardiovascular risk despite breakthroughs in conventional treatment. Immunometabolism, defined as the bidirectional connection of cellular metabolism and immune-cell activity, is an emerging approach for understanding the relationship between metabolic failure and cardiovascular inflammation. Several regulatory pathways, such as AMPK, mTOR, NLRP3, SIRT1, and NRF2, have been linked to metabolic and inflammatory responses in CVD. This review critically assesses the molecular evidence relating these pathways to CVD and investigates the potential for specific phytochemicals and phytomedicines to modify cardiovascular immunometabolism. Curcumin, resveratrol, berberine, quercetin, and andrographolide have all been shown to have pathway-specific effects in cellular and animal models of inflammation, oxidative stress, mitochondrial function, macrophage responses, and endothelial dysfunction. However, mechanistic activity should not be confused with demonstrated cardiovascular therapeutic effectiveness. Poor bioavailability, phytochemical variability, insufficient standardisation, pharmacokinetic uncertainty, possible herb-drug interactions, and a lack of sufficiently powered randomised clinical studies continue to impede translation. Future research should focus on standardised formulations, mechanistic validation in relevant cardiovascular models, pharmacokinetic and safety characterisation, and well-designed clinical trials combining immunometabolic biomarkers. The integration of multi-omics, systems pharmacology, nanophytomedicine, and computational techniques may help to advance evidence-based phytopharmaceutical development.