The new face of atherosclerosis

Findings in cell cultures, experimental animals, human lesions and human populations have, over the past decade, provided a new perspective of atherogenesis. Some of the more important findings are reviewed here. They permit the conclusion that atherosclerosis is a chronic inflammatory disease in which the activities of macrophages are responsible for the development of the lesion. The death of macrophages may be the cause of progression to advanced plaque. Only the advanced plaque causes the stenosis, thrombosis and ischaemia that are responsible for the fatal complications of the disease. There is evidence, as yet persuasive rather than conclusive, that lipid oxidation is an important mechanism in atherogenesis. If so, dietary supplementation with antioxidants such as vitamin E might be effective in postponing the development of the complications.