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Updated: Jun 13, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Differential roles of eosinophils in cardiovascular disease
Junyan Xu1,2, Junli Guo2,3, Tianxiao Liu1,4
1Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Insights
Eosinophils play complex roles in cardiovascular diseases (CVDs). While sometimes protective in acute settings like myocardial infarction, they can promote chronic conditions such as atherosclerosis and thrombosis.
Area of Science:
- Immunology
- Cardiovascular Medicine
- Innate Immunity
Background:
- Eosinophils are key innate immune cells involved in allergic reactions.
- Emerging evidence highlights their dual role in cardiovascular disease (CVD) pathogenesis.
- Clinical findings on eosinophil counts and CVD risk present conflicting results.
Purpose of the Study:
- To review and synthesize clinical and preclinical data on eosinophil involvement in CVD.
- To explore the seemingly contradictory roles of eosinophils in various cardiovascular conditions.
- To elucidate the mechanisms underlying eosinophil's protective and detrimental effects in CVD.
Main Methods:
- Comprehensive review of existing clinical studies correlating eosinophil levels with CVD.
- Analysis of preclinical research investigating eosinophil functions in cardiovascular models.
- Synthesis of data to reconcile conflicting observations regarding eosinophil's impact on CVD.
Main Results:
- High eosinophil counts are linked to increased risk for myocardial infarction, atherosclerosis, and abdominal aortic aneurysm.
- Conversely, low eosinophil counts are associated with risks of heart failure, stroke, and deep vein thrombosis.
- Preclinical data suggest protective roles in acute myocardial infarction and cardiac hypertrophy, but pro-atherogenic roles in chronic CVD.
Conclusions:
- Eosinophils exhibit context-dependent roles in CVD, acting protectively in acute phases and detrimentally in chronic phases.
- Factors like CVD status, timing of eosinophil measurement, and tissue-specific eosinophil functions contribute to observed discrepancies.
- Further research is needed to fully understand and potentially target eosinophil pathways in cardiovascular health.
Abstract:
Eosinophils are essential innate immune cells in allergic responses. Accumulating evidence indicates that eosinophils also participate in the pathogenesis of cardiovascular diseases (CVDs). In clinical studies, high blood eosinophil counts and eosinophil cationic protein levels have been associated with an increased risk of CVD, including myocardial infarction (MI), cardiac hypertrophy, atrial fibrillation, abdominal aortic aneurysm (AAA) and atherosclerosis. However, low blood eosinophil counts have also been reported to be a risk factor for MI, heart failure, aortic dissection, AAA, deep vein thrombosis, pulmonary embolism and ischaemic stroke. Although these conflicting clinical observations remain unexplained, CVD status, timing of eosinophil data collection, and tissue eosinophil phenotypic and functional heterogeneities might account for these discrepancies. Preclinical studies suggest that eosinophils have protective actions in MI, cardiac hypertrophy, heart failure and AAA. By contrast, cationic proteins and platelet-activating factor from eosinophils have been shown to promote vascular smooth muscle cell proliferation, vascular calcification, thrombomodulin inactivation and platelet activation and aggregation, thereby exacerbating atherosclerosis, atrial fibrillation, thrombosis and associated complications. Therefore, eosinophils seem to promote calcification and thrombosis in chronic CVD but are protective in acute cardiovascular settings. In this Review, we summarize the available clinical and preclinical data on the different roles of eosinophils in CVD.
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