The pathogenesis of atherosclerosis.

Atherogenesis is a complex process. While genetic factors determine the limits under which atherosclerosis develops, environmental factors help to determine a person's risk within these limits. Atherosclerosis proceeds through a series of pathological stages: (a) intimal medial thickening; (b) fatty streaks; (c) intermediate lesions; (d) fibrous plaques; (e) complicated plaques. The key cell types involved in atherosclerosis include endothelial cells, monocytes/macrophages, smooth muscle cells, lymphocytes and platelets. Several hundred gene products have been targeted as potential candidates in the analysis of the genetic component of atherosclerosis. In addition to heredity, the classical risk factors for atherosclerosis include male sex, advancing age, cigarette smoking, high blood pressure, diabetes and abnormal plasma lipids. Ideally, the information derived from newer molecular approaches to define the etiology of atherosclerosis could be integrated into evidence-based practice strategies in order to enhance health care delivery to subjects at high risk.