Thrombo-inflammation in cardiometabolic disease

Abstract Cardiometabolic disorders like obesity and diabetes are closely linked with activated coagulation and inflammatory and immune signaling, leading to increased risk of thromboembolism and stroke. In this review, we elaborate recent clinical and basic science insights into the causal and bidirectional links between thrombo-inflammation - settings of activated coagulation and inflammation - and cardiometabolic disease. We discuss how metabolic disorders provide early triggers for a pro-coagulant state, notably endothelial dysfunction, platelet hyperreactivity and an imbalance between pro-coagulant and fibrinolytic signals, and how the interplay with inflammation and immune signaling impacts on cardiac and adipose tissues and ultimately clinical outcome. We discuss possible sex differences and highlight candidate biomarker signatures that could improve timely detection of thrombo-inflammation, and review the recent evidence and remaining challenges of currently available therapeutic strategies.