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Atherogenesis and Vascular Biology

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Therapeutic Lipidology

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Atherosclerotic disease is widely prevalent throughout the world and is a manifestation of a maladaptive response of the arterial vasculature to progressive injury. Arteries are histologically, biochemically, and physiologically complex conduits of blood that can undergo continuous structural alteration in response to cardiovascular risk factors (hyperlipidemia, hypertension, diabetes) as well as an extraordinary range of chemical influences that promote inflammation, oxidation, and thrombosis. Atherosclerosis is characterized by endothelial dysfunction, extensive histologic and connective tissue alterations of the intima, media, and adventitia, and an influx of inflammatory white cells from the blood into the subendothelial space. As the inflammatory and oxidative milieu in the arterial wall intensify, foam cells and fatty streaks develop, ultimately resulting in the formation of atheromatous plaques if the inciting factors are not brought under control. Plaque enlarges and can become vulnerable to rupture from superficial erosions or thinned fibrous cap regions, intra-plaque hemorrhage, or cholesterol crystal formation. With the exposure of tissue factor and collagen, platelets are activated and can form an overlying thrombus on the plaque leading to the development of acute tissue ischemia and necrosis. Atherogenesis is a tightly coordinated process that integrates many biochemical signaling pathways both within and between cells. The progression of atherosclerotic plaque can be arrested with appropriate intervention, and if not yet calcified, plaque can be regressed. There are many gaps in our knowledge of atherogenesis, but great strides have been made in our understanding of this disease during the past three decades.

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  1. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Peter P. Toth

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  1. The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Michael H. Davidson

  2. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Univerity School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  3. Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA

    Kevin C. Maki

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Toth, P.P. (2021). Atherogenesis and Vascular Biology. In: Davidson, M.H., Toth, P.P., Maki, K.C. (eds) Therapeutic Lipidology. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-56514-5_2

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