From risk factors to plaque development and plaque destabilization

This chapter begins with a discussion of recent vascular research that has unveiled the complex interaction between exposure to risk factors and pathological changes at the vessel wall. Risk factors such as smoking or hyperlipidaemia first cause a pre-morbid phenotype with reversible dysfunction of flow-mediated vasodilation, known as endothelial dysfunction (ED). If exposure to risk factor(s) does not cease, ED develops into the first morphological vascular changes that finally lead to atherosclerosis. Cholesterol crystals have been shown to lead to pro-inflammatory activation of macrophages. Progression from stable coronary plaques to the plaque rupture that underlies the acute coronary syndrome is discussed in detail. The chapter provides a basic up-to-date concept of the development and progression of atherosclerosis and highlights the stages where preventive measures may still be effective.