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We
know many factors that contribute to the development of atheromas, but
what sets the process off is still not entirely clear.
One idea is the response
to injury hypothesis. This idea proposes that atherosclerosis is a
chronic inflammatory process of the arterial wall, initiated by endothelial
injury.
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Endothelial injury leads to
increased
permeability and increased leukocyte adhesion.
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Insudation of cholesterol rich
lipoproteins, primarily LDL and VLDL, into the wall, and eventually
their oxidation.
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Adhesion of blood monocytes
to the endothelium, and their migration into the wall followed by transformation
into macrophages and foam cells.
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Adhesion of platelets and release
of factors promoting migration of smooth muscle cells into the plaque.
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Proliferation of smooth
muscle cells.
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Enhanced accumulation of
lipid, both intra and extracellular.
Here's
an illustration
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