Beyond metabolism and blood flow: toward an inflammation-metabolism axis paradigm for herbal medicine in obesity-related coronary heart disease.

Patients with obesity-related coronary heart disease continue to experience substantial residual cardiovascular risk despite progress in secondary prevention. We propose that this risk originates from a self-perpetuating cycle between inflammation and metabolism-termed the inflammation-metabolism axis-which extends beyond conventional risk factors. This axis forms a complex pathological network that existing single-target therapies cannot adequately address, representing a core mechanism of persistent residual risk. Effective management therefore requires integrated strategies capable of systemically modulating this network. Herbal medicines, with their inherent multi-target properties and network-level activity, offer a dual opportunity: they act as both potential therapeutic agents and as scientific tools for validating this integrative paradigm. This perspective article outlines the inflammation-metabolism axis as a unifying framework and discusses the rationale and future directions for developing systemic herbal-based interventions to mitigate residual cardiovascular risk.