Gustavo Escalada-Lesme, Servicio de Cardiología Clínica, Gran Hospital Nacional de Itauguá, Itauguá, Paraguay
Cardio-reno-metabolic diseases represent one of the leading contemporary health challenges, and their rapid increase over a relatively short evolutionary timescale suggests a mismatch between ancestral human biology and the modern environment. The objective of this study was to develop a structured narrative review and propose a conceptual framework integrating evolutionary, pathophysiological, and clinical evidence under the Homo cardiovascularis model. A structured narrative review was conducted, organized across hemodynamic, autonomic, inflammatory, metabolic, epigenetic, and regional domains. Evidence was selected based on its conceptual relevance and its contribution to mechanistic integration rather than quantitative synthesis. The proposed model suggests that physiological adaptations originally advantageous, such as sodium conservation, arterial elasticity, autonomic variability, and metabolic flexibility, may become maladaptive when chronically expressed in environments characterized by caloric excess, sedentary behavior, circadian disruption, and persistent psychosocial stress. Within this framework, Homo cardiovascularis is introduced as a conceptual and interpretative model that may help to integrate multiple pathophysiological pathways involved in cardiorenometabolic disease. It is not intended to define a clinical entity or a validated phenotype, but rather to provide a unifying perspective to reinterpret existing evidence and generate testable hypotheses. This approach may contribute to a more integrated understanding of cardio-reno-metabolic risk, support the development of biologically coherent preventive strategies, and inform future research on the interaction between environment, biology, and disease, particularly in the Inter American context.
Keywords: Evolutionary mismatch. Cardiovascular diseases. Arterial stiffness. Epigenetics. Inflammation. Heart failure.
