Immune cell signatures predict near-term atherosclerosis risk

Immune cell configuration, not cholesterol alone, determines who develops atherosclerosis. In a three-year longitudinal study of 49 healthy older adults (mean age 63.8 years), 30.3% of those initially free of subclinical atherosclerotic plaques developed them during follow-up. Researchers found that baseline immune signatures—particularly lower frequencies of CD8+ effector memory T cells and higher frequencies of regulatory T cells (Tregs)—significantly predicted this risk. Over time, expansion of CD8+ EM cells emerged as the most robust independent predictor of new plaque formation, accompanied by declining Tregs and a lower Treg/Teff ratio. These immune signatures outperformed metabolic variables, visceral fat gain, and circulating inflammatory markers in predictive strength, suggesting that immunological profiling could identify individuals at elevated vascular risk before clinical manifestation occurs.