Atherosclerosis: pathogenesis and pathology

Atherosclerosis and its clinical sequelae represent a huge and increasing global burden of morbidity and mortality in the form of coronary artery, peripheral vascular and cerebral vascular disease. The classical atherosclerotic lesion is an inflammatory fibrofatty plaque. Early notions of atherosclerosis were based on progressive calcification, however, atherosclerosis is now appreciated to be chronic and multifaceted, and the atherosclerotic plaque an “active biological environment.” The interplay of endothelial dysfunction, lipid accumulation, immune response, vascular smooth muscle cell migration, matrix turnover, and calcification is gradually being unravelled. Such insights are already leading to changes in diagnosis and management of patients with atherosclerosis. Serum biomarkers, non-invasive imaging, and genetic testing are being actively investigated for future clinical application. In this review, we provide an overview of pathological findings and the current understanding of the pathogenesis of atherosclerosis and offer some insights into the direction of atherosclerosis research.