**8. Summary**

It appears that many of the risk factors generally associated with cardiovascular risk, like diabetes, endothelial dysfunction, sympathetic over stimulation, all may have an under- appreciated component that is immune/inflammation mediated, and that may include an autoimmune component. Systemic inflammatory diseases without infectious triggers, airborne particles, manufactured nanoparticles, and some therapeutics used in the treatment of other diseases all may exaggerate the consequences of a cardiovascular inflammatory reaction. Some compounds, like doxorubicin, have well established mechanistic profiles that may provide insight as to how each of the mediators is adding to the cardiovascular risk, or injury expansion progression profile. It seems clear that future management of cardiovascular risk will need to become more personalized, and with greater appreciation for a much larger menu of contributing factors, all of which will require development of better biomarker screens than what are currently in use. Immunomodulating agents likely will also have an increasingly important role in limiting progression of heart failure.
