Pathogenesis of atherosclerosis: state of the art.

The practical implementation of the results of large, well-controlled clinical and epidemiologic studies has led to substantial progress in the prevention of atherosclerosis. Now, daring and aggressive interventions, as well as a new understanding of cellular and molecular mechanisms of atherogenesis, also provide new possibilities of effective treatments at an advanced, symptomatic stage of the disease. An abundance of new information has come from an increasing number of seemingly unrelated scientific fields, ranging from laser optics to genetic engineering. This short study examines how some selected new findings and concepts fit into the traditional theories of atherogenesis: encrustation, infiltration, and response to injury. Endothelial and smooth muscle cells, platelets, and leukocytes are viewed in their dual capability of promoting as well as inhibiting the atherogenic process. Mechanisms of vascular healing and intimal hyperplasia after physical interventions are distinguished from those leading to complicated spontaneous atherosclerotic plaques, and the impact of some new ideas on potential pharmacologic interventions is brought to the reader's attention.