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IL-18 acts as a biologically plausible but unvalidated target for atherosclerosis managementUnderstanding the Role of Interleukin 18 in Heart Disease and Plaque Growth

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Key Takeaway
Note that IL-18 is a biologically plausible but currently unvalidated cardiovascular target for atherosclerosis.

This narrative review synthesizes current knowledge regarding the role of Interleukin-18 (IL-18) in atherosclerosis. The authors examine experimental data, human studies of inflamed plaques, its utility as a biomarker, and Mendelian randomization findings to evaluate IL-18 as a cardiovascular target.

Experimental studies indicate that IL-18 supports pro-atherogenic actions, though these effects vary depending on plaque stage, cellular context, and genetic background. Human studies show consistent enrichment of IL-18 in inflamed plaques. However, the review notes that circulating IL-18 shows limited independent performance as a diagnostic or prognostic marker after multivariable adjustment in several large cohorts.

Mendelian randomization supports associations between IL-18 and selected cardiovascular outcomes. Despite these findings, the authors note significant limitations: Mendelian randomization is vulnerable to pleiotropy, instrument strength, ancestry, and lifelong-exposure assumptions. Furthermore, the efficacy of direct IL-18 inhibitors has not been established in clinical practice.

Clinically, IL-18 is positioned as a biologically plausible but unvalidated cardiovascular target. Current evidence does not support its use as an independent diagnostic marker or as a validated therapeutic target at this time.

How this fits prior evidence

This narrative review addresses a gap in the understanding of inflammatory mediators in atherosclerosis. While previous coverage has identified protein acetylation and specific miRNAs as critical regulatory hubs for inflammation, this review focuses on IL-18 as a specific cytokine involved in plaque inflammation. It adds to the landscape of potential targets but notes that unlike some established pathways, IL-18 remains unvalidated as a clinical target.

Interleukin-18, or IL-18, is a protein that plays a role in inflammation. In people with heart disease, this protein is often found in high amounts within plaques. These are the fatty deposits that build up inside your arteries and can lead to serious heart problems.

Laboratory tests show that IL-18 can contribute to the growth of these plaques. However, its effects can change depending on the stage of the disease and the specific genes a person has. While it is clearly involved in the process, its exact role is still being studied by experts.

Doctors are also looking at whether measuring IL-18 in the blood can help predict heart risks. So far, results have been mixed when compared to other common tests. Additionally, while some genetic studies suggest a link between IL-18 and heart health, more clinical trials are needed to prove if drugs targeting this protein will actually help patients.

What this means for you:
IL-18 is linked to heart plaque growth, but it is not yet a proven tool for diagnosis or treatment.

Common questions

What role does IL-18 play in heart disease?

Experimental studies show that IL-18 can promote the growth of plaque in arteries. However, its effects can vary based on the stage of the plaque and the specific cellular environment. In human tissues, this protein is consistently found in plaques that are inflamed.

Can doctors use IL-18 levels to diagnose heart problems?

Currently, using circulating IL-18 as a standalone marker for diagnosis or predicting outcomes has shown limited success in large studies. While it is linked to certain heart outcomes in genetic models, it is not yet an established tool for clinical diagnosis.

Is there a drug that targets IL-18 to treat heart disease?

While IL-18 is considered a plausible target for future research, the effectiveness of drugs that directly inhibit IL-18 has not been established yet. More clinical evidence is needed before it can be used as a standard treatment.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
Atherosclerosis is a chronic inflammatory disease shaped by interactions among vascular cells, innate immunity, adaptive immunity, and metabolic stress. Interleukin-18 (IL-18), an IL-1 superfamily cytokine activated predominantly downstream of inflammasomes, links vascular injury to type 1 immune responses. This structured narrative review integrates mechanistic, plaque-tissue, epidemiological, genetic, and therapeutic evidence for IL-18 in atherosclerosis. Experimental studies generally support pro-atherogenic actions, but these effects vary by plaque stage, cellular context, and genetic background. Human studies consistently show enrichment of IL-18 in inflamed plaques, whereas circulating IL-18 has limited independent diagnostic or prognostic performance after multivariable adjustment in several large cohorts. Drug-target Mendelian randomization supports associations with selected cardiovascular outcomes, but does not substitute for randomized clinical evidence and remains vulnerable to pleiotropy, instrument strength, ancestry, and lifelong-exposure assumptions. Direct IL-18 inhibitors have entered clinical development in inflammatory diseases, yet cardiovascular outcome efficacy has not been established. We therefore position IL-18 as a biologically plausible but unvalidated cardiovascular target and outline a stage-gated translational agenda centered on free IL-18 assays, plaque-context biomarkers, pharmacology, patient selection, and long-term safety.
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