Vaccinium angustifolium's anthocyanin-rich polyphenol profile demonstrates measurable improvements in cardiovascular and metabolic markers through multiple biological pathways. Expert analysis of current clinical data reveals both acute and sustained benefits to glucose regulation, lipid profiles, and vascular function, with concurrent positive effects on gut microbiota composition and cognitive performance. The mechanistic evidence points to anthocyanins as primary bioactive compounds targeting inflammation, endothelial function, and insulin sensitivity simultaneously. This multi-target approach distinguishes wild blueberries from single-compound interventions in cardiometabolic research. However, the field faces significant methodological challenges that temper enthusiasm. Individual response variability remains poorly understood, with some studies showing modest or inconsistent effects across different populations. The lack of standardized dosing protocols and biomarker panels makes cross-study comparisons difficult. Most concerning is the limited understanding of optimal dosing strategies and food matrix interactions that could maximize bioavailability. While the polyphenol density of wild varieties exceeds cultivated berries, translating this biochemical advantage into reliable clinical outcomes requires more rigorous precision nutrition approaches. The evidence suggests promise but demands better-designed trials to move beyond the current equivocal state.