The Case for Bringing Immunology Expertise to Bear in Heart Care (Podcast)

The body’s immune system can impact cardiovascular health in any number of ways. In some cases, cytokines cause inflammation that can weaken the heart and lead to fibrosis. In other cases, immune system activation can trigger blood clot formation, with potential thromboembolic effects. In cases of acute illness, immune system effects on the blood vessels can reduce blood pressure and put excess strain on the heart.

For these and other reasons, Cleveland Clinic’s Heart, Vascular and Thoracic Institute is elevating the role of cardioimmunology expertise in the care of appropriate patients through the creation of a cardioimmunology center led by a new staff physician, David Zidar, MD, PhD, an interventional cardiologist with PhD-level training in immunology.

In a recent episode of Cleveland Clinic’s Cardiac Consult podcast, Dr. Zidar sits down with Cleveland Clinic Cardiovascular Medicine Chair Samir Kapadia, MD, to explore the intersection of immune pathways and cardiovascular disease. They address the following topics, among others:

• The immune system’s impact on the heart
• Connections between stress and automimmune diseases affecting the heart
• Clonal hematopoiesis and immune monitoring
• Integration of immunologic markers with electronic health data for early identification of at-risk patients
• The role of a cardioimmunology center for disease screening and prevention

Click the podcast player above to listen to the 14-minute episode now or read on for an edited excerpt. Check out more Cardiac Consult episodes at clevelandclinic.org/cardiacconsultpodcast or wherever you get your podcasts.

Excerpt from the podcast

Samir Kapadia, MD: We are also studying CHIP [clonal hematopoiesis of indeterminate potential] mutations in the peripheral blood. Do you think there are immunologic parameters we can similarly study in the blood to determine ways in which someone may or may not be healthier than expected? And if you do some intervention, could you correct or monitor how to measure the immunologic response?

David Zidar, MD, PhD: To understand the large population-level issues, it may help to drill down into very specific populations, such as people who have clonal hematopoiesis. That’s where people, as they age, have some immune cells that outcompete others, and those are not always the best-behaved cells. Those monocytes tend to do behaviors that are adverse to the heart and to the blood vessels through immunologic pathways that are pretty well described and probably pretty active in many of us. By really understanding this small niche of patients, we can hope to then understand larger concepts that are applicable to all of us.

Dr. Kapadia: My point is that, for people who want to be healthier, there are many different things to monitor. Currently we monitor cholesterol, blood pressure and other measures, and we encourage exercise. Also, it’s important that the whole body be immunologically well regulated so that if there is an adverse event or something happens, the body can fight it. So, is it reasonable to say that with all these efforts, we can identify people who are at higher risk, using these novel pathways and novel systems, and make them healthier in the future if we can help regulate their immunology in an appropriate way?

Dr. Zidar: Yes, that’s what drives me to want to pursue this. And I do think it’s practical. There are ways to discover patient populations, nowadays certainly, where so much of our information is electronic and can be processed in large volumes. The idea would be to see the immune system not just as a potential enemy of the heart but as the proverbial canary in the coal mine. The immune system is always surveying tissues, and we can see that activity level play out in certain blood markers. That lends itself well to discovering which patients are at highest risk before they have an adverse event by understanding their immunologic signs and symptoms before something happens that may lead to larger damage down the line.

Dr. Kapadia: Exactly. The point is that, if someone has heart problems or wants to prevent heart problems, these are a few of the things they can try to understand. Or if there is an undiagnosed heart problem for which they are trying to figure out the exact cause or how it may be related to some other finding, this center for cardioimmunology can be very helpful. This is the reason for our efforts to make that available.