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There is a need for decision-support system that can select relevant features. We propose a Cardio Meta Hybrid Optimizer (CMHO) framework designed to enhance feature selection and predictive accuracy in cardiac risk assessment.The CMHO framework integrates three metaheuristic algorithms\u2014Lion Optimization (LO), Marine Predators Algorithm (MPA), and Manta Ray Foraging Optimization (MRFO)\u2014enhanced with adaptive switching, dynamic mutation, and iterative local search (ILS). The framework was evaluated on five benchmark datasets: Cleveland, Hungarian, Statlog, Switzerland, and Long Beach VA. We uesd a CNN-LSTM architecture for classification, validated through stratified tenfold cross-validation with 10 independent repetitions. Performance was benchmarked against RFE, GA, PSO, GWO, and Lasso using ANOVA to confirm statistical significance. The CMHO-integrated CNN-LSTM model achieved a accuracy of 96.1%, outperforming traditional feature selection methods by 3%\u20135% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). The framework demonstrated stability and clinical interpretability by selecting validated biomarkers\u2014including thalassemia, chest pain type, and maximum heart rate\u2014with a Stability Selection Index (SSI)\u2009&gt;\u20090.90.The CMHO framework provides a robust and interpretable tool for cardiovascular risk assessment. By navigating high-dimensional data across diverse populations, it offers a reliable computational approach for clinical decision support in cardiology.\n                  <\/jats:p>","DOI":"10.1186\/s12859-026-06489-x","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:34:37Z","timestamp":1780997677000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["CardioMetaHybridOptimizer as a behaviorally adaptive multi-phase metaheuristic framework for interpretable cardiovascular disease diagnosis"],"prefix":"10.1186","volume":"27","author":[{"given":"Ahmed Kateb Jumaah","family":"Al-Nussairi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser Taha","family":"Alzubaidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali k. 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