Interleukin-4 (IL-4) and Interleukin-13 (IL-13) are central regulators of the Th2 immune response and play pivotal roles in vascular inflammation, endothelial dysfunction, and cardiovascular remodeling. While their contributions to immune modulation are well known, their precise effects on the cardiovascular system remain an evolving field of study. This review aims to explore the mechanistic roles of IL-4 and IL-13 in endothelial dysfunction and the development of cardiovascular diseases, and to evaluate the therapeutic potential and risks associated with IL-4/IL-13 inhibitors. A narrative review approach was used. Articles published between 2015 and 2025 were identified through PubMed, Scopus, and Google Scholar using relevant keywords. Mechanistic, experimental, and clinical studies examining IL-4/IL-13 signaling and inhibitor outcomes were selected. IL-4 and IL-13 contribute to vascular inflammation by upregulating adhesion molecules, disrupting nitric oxide synthesis via arginase I, and increasing oxidative stress. These cytokines promote vascular remodeling and are linked to hypertension, atherosclerosis, and cardiac fibrosis. Inhibitors like dupilumab show promise in controlling inflammation, but their long-term cardiovascular effects remain unclear. Some studies suggest potential risks such as increased infections, metabolic dysregulation, and vascular stiffening. IL-4 and IL-13 are active mediators in cardiovascular pathology, offering both therapeutic potential and clinical challenges. While inhibitors targeting these cytokines may reduce inflammation, their broader impacts on vascular health warrant cautious and personalized application until long-term cardiovascular outcomes are clarified through further research.

Background: Atherosclerosis is a chronic, progressive vascular disease characterized not only by lipid accumulation but also by sustained inflammation. Recent evidence has highlighted the critical role of immune pathways and pro-inflammatory cytokines in plaque formation, progression, and destabilization. Aim: This narrative review aims to summarize current knowledge regarding the role of inflammation in atherosclerosis and evaluate the therapeutic potential of biologic agents targeting specific inflammatory pathways. Methods: A comprehensive literature search was conducted using keywords such as “atherosclerosis”, “inflammation”, “biologic agents”, and “cytokine inhibitors”. Recent clinical trials and relevant experimental studies were analyzed and synthesized narratively. Results: Biologic agents targeting IL-1β, IL-6, IL-17A, and CD20+ B cells have shown promising results in reducing inflammation and improving cardiovascular outcomes in high-risk patients. Agents such as canakinumab, anakinra, tocilizumab, rituximab, secukinumab, and alirocumab demonstrate varying degrees of efficacy depending on the targeted pathway. However, concerns remain regarding immunosuppression, lipid alterations, cost, and long-term safety. Conclusion: Biologic agents offer a novel, mechanism-based therapeutic approach in managing atherosclerosis. While current data support their benefit in select patient groups, further research is needed to clarify long-term outcomes, safety, and real-world applicability. Personalized treatment strategies based on inflammatory profiles may enhance clinical benefit.

Background: Recent interest has focused on the role of inflammatory markers in assessing coronary artery disease (CAD) severity, especially in the early stages. However, there remains a gap in identifying reliable biomarkers to predict postoperative mortality in patients undergoing coronary artery bypass grafting (CABG). Traditional markers such as C-reactive protein (CRP) and white blood cell (WBC) counts are commonly used but have limitations in specificity and prognostic value. The Delta Neutrophil Index (DNI), which reflects immature granulocyte levels, offers a promising alternative. Unlike CRP and WBC, DNI specifically measures the acute inflammatory response, providing a more targeted indicator of risk. This study evaluates the significance of postoperative DNI as a prognostic marker for early mortality in CABG patients, addressing the need for more accurate biomarkers in postoperative care. Aim: The aim of this study is to determine the significance of the Delta Neutrophil Index (DNI), which reflects the proportion of immature granulocytes, as a prognostic marker for early postoperative mortality in patients undergoing coronary artery bypass grafting (CABG). Methods: This rigorously designed retrospective cohort study was conducted at a high-volume tertiary care center specializing in cardiovascular surgery, including a robust patient cohort to ensure comprehensive data analysis and reliable conclusions. The study included a consecutive series of 446 patients who underwent coronary artery bypass grafting (CABG) between January 1, 2022, and August 1, 2023. Results: Mortality was found to be associated with preoperative DNI (p< 0.05). A 1-unit increase in pre-DNI measurement was associated with a 2.61-fold (95% Confidence Interval: 1.54– 4.45) increase in the risk of death. Additionally, mortality was also associated with postoperative DNI (p< 0.05). A 1-unit increase in postoperative DNI measurement was associated with a 10.21-fold (95% Confidence Interval: 5.08– 20.05) increase in the risk of death. Conclusion: Elevated DNI values are strong independent predictors of postoperative mortality, underscoring its critical role in perioperative risk assessment for CABG patients. Both preoperative and postoperative DNI levels are significantly linked to mortality, emphasizing DNI’s value in improving patient outcomes and reducing complications. Integrating DNI into routine clinical practice can provide a more personalized approach to care, enhancing survival and optimizing postoperative management.

Background: The objective of this study was to evaluate the relationship between both preoperative and postoperative Prognostic Nutritional Index values and postoperative mortality in patients undergoing Coronary Artery Bypass Grafting surgery. Methods: This retrospective cohort study included 440 patients who underwent Coronary Artery Bypass Grafting between March 2021 and April 2023. Preoperative and postoperative Prognostic Nutritional Index values were calculated based on serum albumin concentration and peripheral blood lymphocyte count. The primary outcome was mortality, with statistical analyses performed to assess the association between Prognostic Nutritional Index values (preoperative and postoperative) and mortality using univariate and multivariate methods. Results: A significant correlation was found between low preoperative Prognostic Nutritional Index and increased postoperative mortality risk (P < .05). A 1-unit increase in preoperative Prognostic Nutritional Index was associated with a 5% reduction in mortality risk (Odds ratio [OR] = 0.95, P < .001, 95% CI: 0.96-0.98). Similarly, the postoperative Prognostic Nutritional Index was significantly associated with mortality, with a 1-unit increase in postoperative Prognostic Nutritional Index corresponding to a 6% reduction in mortality risk (OR = 0.94, P < .001, 95% CI: 0.92-0.96). Both preoperative and postoperative Prognostic Nutritional Index values independently predicted mortality risk, with postoperative Prognostic Nutritional Index showing a stronger association with mortality outcomes. Conclusions: The study demonstrates that both preoperative and postoperative Prognostic Nutritional Index values are critical predictors of mortality risk in Coronary Artery Bypass Grafting patients. Early assessment of the Prognostic Nutritional Index, both preoperatively and postoperatively, could enhance risk stratification and improve patient outcomes through timely interventions.

Objective: Systemic inflammation triggered by cardiopulmonary bypass (CPB) plays a critical role in postoperative complications and mortality. The Delta Neutrophil Index (DNI), which quantifies circulating immature neutrophils, is increasingly recognized as a marker of systemic inflammation. While its utility has been demonstrated in sepsis and non-cardiac surgeries, its role in cardiac procedures remains underexplored. This study aimed to evaluate the relationship between intraoperative DNI levels and postoperative mortality in patients undergoing open-heart surgery with CPB. Methods: This retrospective observational study included 245 patients who underwent CPB between January 2022 and July 2023. DNI was measured at five predefined time points: induction, 5, 45, and 90 min after CPB initiation, and immediately postoperatively. Patients were categorized into two groups based on in-hospital mortality: those who experienced mortality (“Ex” group, n = 67) and those who survived (“Non-Ex” group, n = 178). Logistic regression was used to assess the association between DNI values and mortality. Results: DNI levels were significantly higher in the Ex group at induction (1.22 ± 0.96 vs 0.47 ± 0.39; p = 0.002), 5 min (2.04 ± 1.07 vs 1.08 ± 0.58; p < 0.001), 90 min (1.76 ± 0.84 vs 1.07 ± 0.81; p = 0.004), and postoperatively (2.14 ± 1.38 vs 0.58 ± 0.32; p < 0.001). Each unit increase in postoperative DNI was associated with a 21.78-fold increase in mortality risk (95% CI: 6.12–67.92; p < 0.001). CPB and cross-clamp durations were also significantly longer in Ex patients. Conclusions: Elevated intraoperative and postoperative DNI levels are strongly associated with increased in-hospital mortality following CPB. DNI may serve as a dynamic and practical biomarker to aid perioperative risk stratification, pending further validation. Incorporating DNI into routine intraoperative monitoring may enhance early identification of high-risk patients and improve postoperative outcomes.

Early in-hospital mortality remains an important concern after coronary artery bypass grafting. Existing risk scores, such as EuroSCORE and STS, rely mainly on demographic and clinical parameters and do not adequately incorporate routine hematological markers. This study aimed to develop and validate the Hematological Inflammatory Gradient Score (HIGS), a novel model derived from routinely available hematological indices, to predict early postoperative mortality after coronary artery bypass grafting (CABG). A retrospective, single-center cohort of 202 patients undergoing elective isolated CABG between January 2022 and March 2024 was analyzed. HIGS was calculated using standardized z-scores of red cell distribution width (RDW), platelet distribution width (PDW), and immature granulocyte percentage (IG%). Discrimination was assessed with ROC curve analysis, while logistic regression identified independent predictors of mortality. In-hospital mortality occurred in 10.9% (22/202) of patients. Compared with survivors, non-survivors had significantly higher HIGS values (1.02 ± 0.74 vs –0.12 ± 0.43, p < 0.001). HIGS demonstrated the highest discriminative ability for mortality prediction among tested parameters (AUC = 0.862, 95% CI: 0.794–0.931), with 86.4% sensitivity and 78.9% specificity at the optimal cut-off (>0.44). When added to the base model consisting of age, ejection fraction, and urea, HIGS provided a modest improvement in discrimination (AUC increase from 0.639 to 0.665). In multivariate analysis, lower ejection fraction, higher IG%, and elevated urea were independent predictors of mortality, and inclusion of HIGS improved model performance. HIGS is a simple, inexpensive, and biologically plausible score derived from routine blood tests that reliably stratifies early mortality risk after CABG. If confirmed in larger, prospective multicenter studies, HIGS may serve as a practical adjunct to conventional risk models in perioperative decision-making. Given the retrospective, single-center design and limited event count, these findings should be interpreted cautiously, and external validation is required.