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Elevated Interleukin-6 Levels in Socioeconomically Disadvantaged Children With Borderline Subclinical Rheumatic Heart

Carlos Eduardo de Barros Branco1,2, Alessandra Santos Lima Gazola1, Carlos Augusto Homem de Magalhães Campos1

  • 1Heart Institute (InCor) University of São Paulo Medical School São Paulo Brazil.

Journal of the American Heart Association
|April 7, 2026
PubMed

Insights

Subclinical rheumatic heart disease (SCRHD) shows elevated interleukin-6 (IL-6) levels in its earliest stages, persisting for at least two years. This indicates ongoing inflammation and identifies IL-6 as a potential early biomarker for preventing SCRHD progression.

Area of Science:

  • Cardiology
  • Immunology
  • Pediatrics

Background:

  • Subclinical rheumatic heart disease (SCRHD) precedes symptomatic disease, but its early cytokine profile is unknown.
  • Investigating inflammatory markers in borderline SCRHD is crucial for understanding disease progression.
  • This study examined the cytokine profile in borderline SCRHD and its longitudinal changes.

Purpose of the Study:

  • To characterize the cytokine profile in borderline SCRHD at baseline.
  • To evaluate the longitudinal evolution of inflammatory markers over a 2-year period in SCRHD patients.
  • To identify potential early biomarkers for SCRHD.

Main Methods:

  • A prospective cohort study of 1026 children (5-15 years) in São Paulo, Brazil.
  • Echocardiographic screening classified participants as normal, borderline SCRHD, or definite SCRHD.
  • Plasma levels of IL-6, TNF-alpha, and other cytokines were measured at baseline and after 2 years.

Main Results:

  • SCRHD prevalence was 7.6%, with 6.7% borderline and 0.9% definite.
  • Baseline IL-6 levels were significantly higher in borderline SCRHD compared to controls (P=0.048).
  • IL-6 and TNF-alpha remained persistently elevated over 2 years in followed participants, indicating ongoing inflammation.

Conclusions:

  • Borderline SCRHD exhibits elevated IL-6 levels lasting at least 2 years, signifying a sustained proinflammatory state.
  • Interleukin-6 is identified as a potential early biomarker for SCRHD.
  • Targeting IL-6 may offer a strategy to prevent SCRHD progression.
Abstract

Keywords:
IL‐6TNF‐αborderlinecytokinesinflammationrheumatic heart diseasesubclinicaltherapeutic strategies

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