Development of the atherosclerotic plaque

Atherosclerosis is a pathological condition that is characterized by the development of plaques within arteries. There are numerous known risk factors for the development of atherosclerosis, including elevated plasma concentrations of cholesterol, in particular the low-density lipoprotein (LDL) fraction, hypertension, diabetes mellitus, smoking, and genetic predisposition (1-3). This disease is thought to be inflammatory in nature with lesions involving both lipid and cellular accumulation within the vessel wall and reactive intimal thickening of the artery (4). The onset of disease begins as early as childhood with the development of the fatty streak (5, 6), followed by lipid deposition and accumulation of both extracellular matrix and intimal smooth muscle cells (7). Once the characteristic plaque has formed, it may remain asymptomatic for many years. However, as the disease progresses, ischemia can occur with progressive occlusion of the vessel, or the plaque can suddenly rupture, resulting in thrombus formation. Rupture of a plaque frequently results in one of the acute coronary syndromes, which include sudden death, acute myocardial infarction, or unstable angina (8, 9).