Cardioimmunology ReviewAn introduction
Cardioimmunology
The heart and the immune system
At the intersection of cardiology and immunology
Cardioimmunology studies the relationships between the immune system, the heart and cardiovascular disease. It considers tissue homeostasis as well as injury and repair. [1]
The field brings together cell biology, pathophysiology and clinical observation. It asks which cells are involved, in which tissue, at what stage and with what consequences. The role of an immune response depends on its context; activation alone does not establish that it should be inhibited.
The review by Swirski and Nahrendorf provides an overview of these questions. The examples below chiefly illustrate why different levels of evidence need to be distinguished. [1]
From studies to evidence
Experimental research
Macrophages and conduction
Hulsmans and colleagues showed, notably in mice, that resident macrophages contribute to electrical conduction in the atrioventricular node. [2]
An experimental mechanism can explain a function; it does not by itself establish a treatment indication in humans.
Randomised clinical trial
Inflammation and atherothrombotic risk
In CANTOS, canakinumab at 150 mg every three months reduced recurrent cardiovascular events in selected patients with previous myocardial infarction and persistent inflammation. Treatment was also associated with more fatal infections. [3]
The finding applies to a defined population and intervention. It does not establish immunomodulation as a treatment for every cardiovascular disease.
Clinical practice guidelines
Myocarditis, pericarditis and imaging
The 2025 ESC guidelines structure the assessment of myocarditis and pericarditis, incorporating echocardiography, cardiac magnetic resonance and, in selected circumstances, endomyocardial biopsy. [4]
Imaging findings must be interpreted alongside the clinical context and other investigations; they do not alone identify a specific immune cause.
Reading mechanisms in their clinical context
Several questions separate a biological observation from a medical decision:
- Does the result come from an experimental model, a human observational study or a comparative trial?
- Does the outcome describe a mechanism, an intermediate marker or a benefit for patients?
- Do the population, methods and uncertainties support applying the conclusion to the situation being considered?
This introduction offers a framework for reading; it is neither a systematic review nor a clinical management guideline.
Further reading
The Method, Cardioimmunology. Book 2, by Brahim Abdelouaeb, explores critical appraisal and the construction of evidence. Both editions are presented in the Cardioimmunology Review collection.
References
- Swirski FK, Nahrendorf M. Cardioimmunology: the immune system in cardiac homeostasis and disease. Nat Rev Immunol. 2018;18:733–744.
- Hulsmans M, et al. Macrophages Facilitate Electrical Conduction in the Heart. Cell. 2017;169:510–522.e20.
- Ridker PM, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017;377:1119–1131.
- Schulz-Menger J, et al. ESC — Myocarditis and pericarditis guidelines (2025). Eur Heart J. 2025;46:3952–4041.
Selected references checked on 16 October 2026