The central nervous system and atherogenesis: endothelial injury

Although it has been widely acknowledged that endothelial injury is an important contributing factor to the pathogenesis of atherosclerosis, and may even represent an initiating event, morphologic documentation of its occurrence both in humans and animals has been difficult to obtain. However, electrical stimulation of the lateral hypothalamus in conscious, unrestrained animals on normal diets induces severe endothelial damage with cell loss and denudation in both aortas and coronary arteries. Continued stimulation results in intimal lesions with features of atherosclerotic plaques. The mechanism by which stimulation leads to endothelial injury is discussed and involves the induction of vasospasm. These observations are considered in the light of recent clinical and epidemiological studies, in which the role of neuropsychological and behavioral responses to psychosocial stimuli have been considered important risk factors for the development of atherosclerosis.