How Inflammaging Drives Heart Attacks in Older Adults—and Immunotherapy Hopes

A comprehensive new review published in the journal Biogerontology maps out why aging hearts are so vulnerable to myocardial infarction, and it places a single culprit at the center of the story: chronic, low-grade inflammation that intensifies with age, a phenomenon scientists call inflammaging. The review, authored by Sithu Aung, Soe Ei Phyu, Nelli Giribabu and Naguib Salleh of the Department of Physiology at Universiti Malaya, synthesizes mechanistic and translational evidence connecting this age-related inflammatory drift to cytokine dysregulation, cardiovascular cell senescence and impaired cardiac repair. Aging, the authors emphasize, is an independent and non-modifiable risk factor for myocardial infarction, but the biological pathways it activates are increasingly looking like druggable targets.

The core argument of the review is that inflammaging rewires the cytokine networks that coordinate both innate and adaptive immune responses. As the immune system ages, pro-inflammatory signals such as interleukin-6 and interleukin-1 rise while regulatory, anti-inflammatory mediators falter. This imbalance promotes endothelial dysfunction, compromises post-infarction repair and makes the aged myocardium more susceptible to ischemia and adverse remodeling. In practical terms, an older heart does not merely suffer a blocked artery; it responds to that insult with an immune reaction that has been fundamentally altered by decades of inflammatory conditioning.

A central player in this process is cellular senescence, the state in which aged or damaged cells stop dividing but refuse to die, instead secreting a potent cocktail of inflammatory molecules known as the senescence-associated secretory phenotype, or SASP. The review details how senescent cells in the cardiovascular system, including endothelial cells, vascular smooth muscle cells and cardiomyocytes, perpetuate inflammaging by continuously releasing cytokines, chemokines and matrix-remodeling enzymes. This creates a self-reinforcing loop: inflammation drives senescence, and senescent cells amplify inflammation, progressively degrading the structural and functional integrity of the heart and vasculature.

The authors also devote significant attention to inflammasome-mediated pyroptosis, a highly inflammatory form of programmed cell death. When danger signals such as mitochondrial DNA, HMGB1 or S100 alarmin proteins are released from damaged tissue, they can activate the NLRP3 inflammasome, triggering gasdermin D pore formation and explosive release of interleukin-1 beta and interleukin-18. Evidence compiled in the review indicates that this pathway is amplified in the aging heart, contributing to cardiac aging itself and worsening ischemia-reperfusion injury after a heart attack. Experimental studies cited suggest that suppressing NLRP3 can prevent cardiac aging and improve longevity in animal models, and pharmacological inhibitors such as dapansutrile have already been tested in early human trials for heart failure.

On the translational front, the review identifies the interleukin-6 and interleukin-1 signalling axis as the target with the strongest interventional evidence to date. The landmark CANTOS trial demonstrated that canakinumab, a monoclonal antibody against interleukin-1 beta, reduced recurrent cardiovascular events in patients with atherosclerotic disease, providing the first outcome-level proof that tamping down this inflammatory arm can benefit the heart. Meanwhile, the Norwegian ASSAIL-MI trial provided phase 2 myocardial-salvage evidence for tocilizumab, an interleukin-6 receptor blocker, in patients experiencing acute ST-elevation myocardial infarction, with additional analyses documenting favorable shifts in immune cell profiles after interleukin-6 inhibition.

Beyond interleukin-6 and interleukin-1, the review catalogues a dense web of cytokines and chemokines implicated in age-related cardiac injury. Chemokines such as CCL2 and CXCL12 orchestrate monocyte recruitment and stem cell homing, while members of the interleukin-17 family drive fibrosis and arrhythmogenesis after infarction. In contrast, anti-inflammatory interleukins including IL-37, IL-38 and IL-22 appear cardioprotective, attenuating platelet activation, macrophage inflammation and fibroblast metabolic reprogramming. Growth factors such as GDF11 and the longevity-associated protein Klotho add further layers of complexity, with circulating levels shifting in ways that can either exacerbate or mitigate myocardial injury depending on context.

Emerging biomarkers form another pillar of the review. The authors highlight cytokine-based and extracellular vesicle-based diagnostics as promising tools for stratifying cardiovascular risk in older patients. Multiplexed and point-of-care biosensing technologies, augmented by artificial intelligence and machine learning, are making it feasible to track inflammatory signatures in real time. Notably, a deep-learning-derived inflammatory aging clock based on cytokine profiles has been shown to track multimorbidity, immunosenescence, frailty and cardiovascular aging, offering a glimpse of how inflammaging measurements could one day guide personalized treatment decisions in elderly patients presenting with acute coronary syndromes.

The concept of trained immunity also features prominently. Innate immune cells can retain epigenetic and metabolic memories of prior insults, and this memory program appears to be dysregulated in aging and atherosclerosis, fueling exaggerated inflammatory responses. Clonal hematopoiesis, the age-related expansion of genetically altered blood cell clones such as those carrying TET2 mutations, has been shown to accelerate atherosclerosis through inflammatory mechanisms, linking hematopoietic aging directly to cardiovascular risk. Interventions ranging from lifestyle modification to exercise, which promotes anti-inflammatory cytokine release and counters cellular senescence, are discussed as accessible means of tempering inflammaging, alongside nutraceutical and pro-resolving lipid mediator strategies.

Senescence-directed therapeutics represent an especially forward-looking frontier. Senolytic drugs, which selectively eliminate senescent cells, have shown promise in preclinical cardiovascular models, and engineered senolytic CAR T cells have reversed senescence-associated pathologies in experimental systems. Engineered extracellular vesicles are being explored as targeted delivery platforms capable of ferrying microRNAs and other payloads to damaged myocardium. The review argues that combining cytokine-targeted agents with senescence-directed and precision immunology-guided approaches could eventually allow clinicians to tailor anti-inflammatory therapy to the immune fingerprint of each aging patient, a vision embodied by European initiatives aimed at personalized cardiovascular care.

Crucially, the authors temper their optimism with caution. Despite encouraging signals from CANTOS, ASSAIL-MI and related studies, the efficacy and safety of cytokine-based immunotherapies in older populations remain to be established in dedicated clinical trials, and elderly patients are chronically underrepresented in cardiovascular research. Sex and gender differences in immune aging, the influence of the gut microbiota, and the heterogeneity of inflammaging across individuals all complicate the path to precision treatment. Nevertheless, the review concludes that inflammaging is tightly linked to age-related myocardial infarction, and that immunotherapies targeting the interleukin-6 and interleukin-1 axis constitute one of the most promising therapeutic avenues for protecting the aging heart in the years ahead.

Subject of Research: The role of inflammaging and cytokine-driven cardiovascular senescence in age-related myocardial infarction and precision immunotherapy

Article Title: Inflammaging and cytokine-driven cardiovascular senescence in age-related myocardial infarction: mechanisms, biomarkers, and precision immunotherapy strategies

Article References: Aung, S., Phyu, S. E., Giribabu, N., & Salleh, N. (2026). Inflammaging and cytokine-driven cardiovascular senescence in age-related myocardial infarction: mechanisms, biomarkers, and precision immunotherapy strategies. Biogerontology, 27(5), Article 152. https://doi.org/10.1007/s10522-026-10482-5

Image Credits: AI Generated

DOI: 10.1007/s10522-026-10482-5

Keywords: inflammaging, myocardial infarction, cytokines, cardiovascular senescence, NLRP3 inflammasome, pyroptosis, senescence-associated secretory phenotype, interleukin-6, interleukin-1, precision immunotherapy, biomarkers, aging