re-existing cardiovascular diseases, such as hypertension, CAD, cardiac arrhythmias and congestive heart failure, are strong risk factors for severe viral disease, complicated by high morbidity and mortality rates 1,2 . In addition, individuals with cardiovascular comorbidities fail to respond adequately against vaccines 3 . Poor anti-viral immunity in patients with CAD has been exemplified during the recent SARS-CoV-2 pandemic, where a history of CAD was associated with severe symptoms 1 . Patients with CAD generate weak immune responses against varicella zoster virus 4 , and chronic EBV infection has been associated with cardiovascular disease 5,6 . Although the relationship between viral immunity and progression of atherosclerotic disease remains insufficiently understood, the recent pandemic has made clear that a better understanding of protective immunity is needed to inform therapeutic management of virally infected patients with pre-existent cardiovascular disease.Protection against and clearance of viral pathogens depends on the induction of adaptive immunity-in particular, priming and expansion of CD4 + T cells that help antibody-producing B cells and virus-specific CD8 + killer T cells 7 . SARS-CoV-2-specific CD4 + T cells are detected in the peripheral blood of all Coronavirus Disease 2019 (COVID-19) convalescent patients 8 . Patients who have recovered from COVID-19 infection carry CD4 + T cells with specificity for the viral spike and nucleocapsid antigens 9 . A subset of individuals testing negative for SARS-CoV-2 possess such CD4 + T cells, probably induced by the endemic human coronaviruses that cause upper and lower respiratory tract infections in children and adults. Similarly, CD4 + T cells are critical in protecting the host against deleterious effects of EBV infection 10 .Patients with CAD have abnormalities in their innate and adaptive immune system. Transcriptomic and cytometric single-cell analysis of atherosclerotic plaque lesions has identified T cells and Mϕ as the dominant tissue-residing cell types (10% Mϕ and 65% T cells, most being CD4 + T cells 11 ). The precise contribution of CD4 + T cells in inducing and sustaining atherosclerosis is not well-defined, but patients with CAD have expanded clonotypes of IFN-γ high -producing CD4 + CD28 − T cells 12 . These CD4 + T cells are cytotoxic toward endothelial cells, jeopardizing vascular integrity 13 . Besides their role as tissue-destructive effector cells and their contribution in lipid uptake, Mϕ serve as antigen-presenting cells, a pinnacle position in the induction of adaptive immunity. Mϕ from patients with CAD suppress anti-viral T cell immunity due to aberrant expression of the co-inhibitory ligand PD-L1 (ref. 14 ). Whether this defect has relevance in COVID-19 infection and in persistent EBV infection is unknown.Like other professional antigen-presenting cells, Mϕ express an array of co-stimulatory and co-inhibitory ligands that influence communication with interacting T cells. Mϕ critically regulate the balance of T cell activat...