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 Atherosclerosis: Theories of Etiology and Pathogenesis

1. Atherosclerotic lesions

  • Fatty streaks.
  • Gelatinous plaques.
  • Fibrous plaques.
  • Complicated plaques.

2. Theories of atherogenesis

  • Lipid hypothesis.
  • Thrombogenetic hypothesis.
  • Mesenchymal hypothesis.
  • Monoclonal hypothesis.
  • Response to injury hypothesis.

3. Lesion arrest and regression

  • Risk factor modification.
  • Modification of the plaques.


1. Tegos TJ, Kalodiki E, Sabetai MM, Nicolaides AN. The genesis of atherosclerosis and risk factors: a review. Angiology 2001;52:89-98.

In this review the microscopic appearance of the normal arterial wall, the definition of atherosclerosis and the five theories of atherogenesis are described (the lipid theory, the hemodynamic theory, the fibrin incrustation theory, the nonspecific mesenchymal hypothesis and the response to injury hypothesis). The classification of the atherosclerotic lesions according to Stary (types I-VI) as well as the epidemiology and the role of various risk factors are presented in detail.

2. Willeit J, Kiechl S. Biology of arterial atheroma. Cerebrovasc Dis 2000;10 Suppl 5:1-8.

This review article provides insights into the complex biology of arterial atheroma and the etiologic peculiarities of advanced complicated plaques. This knowledge may serve as a basis for identifying high-risk subjects and for novel vascular prevention strategies with focus on plaque stabilization and antithrombotic/anticoagulant measures.

3. Hegele RA. The pathogenesis of atherosclerosis. Clin Chim Acta 1996;246:21-38.

Pathogenesis of atherosclerosis is reviewed including genetic factors, environmental factors, pathological stages and cell types involved in the disease process. Therapeutic implications of this knowledge are also briefly reviewed.

4. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, Rosenfeld ME, Schwartz CJ, Wagner WD, Wissler RW. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 1995;92:1355-1374.

This report describes the characteristic components and pathogenic mechanisms of the various advanced atherosclerotic lesions. An attempt is also made to correlate the appearance of lesions noted in clinical imaging studies with histological lesion types and corresponding clinical syndromes.

5. Dzau VJ. Pathobiology of atherosclerosis and plaque complications. Am Heart J 1994;128:1300-1304.

Endothelial dysfunction, which results from biochemical and hemodynamic stresses associated with cardiovascular risk factors, causes an imbalance in the expression of vasodilating and vasoconstricting substances, as well as excess production of chemoattractant molecules and growth factors. The role of these parameters in the process of atherosclerosis is briefly described.

Posted June 2010