Macrophage states in plaque may help predict heart attack risk

Heart attacks often strike without warning. Doctors look for signs of plaque buildup in arteries, but not all plaques are the same. Some are stable, while others are prone to rupture and cause a blockage. This review explores a new way to look at the immune cells inside these plaques. Specifically, it focuses on macrophages, which are white blood cells that clean up debris but can also drive inflammation. The study looks at how different states of these cells might signal higher or lower risk. Understanding these states could help doctors see who is at greatest danger before a crisis happens. The research points to potential uses in risk stratification, molecular imaging, and targeting specific therapies. However, the findings come with important caveats. The data relied on plaque samples from different sources, which varied in how they were collected and labeled. Differences in how researchers named these cell states also made it hard to compare results directly. Because of these differences, the evidence is currently incomplete. While the potential for better risk prediction is clear, more work is needed to standardize how we measure these cells. Until then, this knowledge remains a promising but unfinished tool for heart care.