Atherogenesis and Inflammation

This chapter reviews the pathogenesis of atherosclerosis and the inflammatory cascades leading to plaque progression and destabilization. New coronary imaging modalities and developments in computer modeling are critiqued as tools to help improve the understanding of cardiovascular diseases. The risk of major thrombotic and thromboembolic complications of atherosclerosis appears to be related more to the stability of atheromatous plaques than to the extent of disease. Much attention has been placed on trying to identify plaques at high risk of disruption leading to thrombosis. The chapter focuses on cellular and molecular mechanisms affecting plaque progression and serum markers correlated to plaque inflammation. Plaque rupture on optical coherence tomography (OCT) is identified by a clear-cut disruption in the signal-rich thin fibrous cap overlying a signal-poor necrotic core resulting in extrusion of highly thrombogenic material into the lumen. Oxidative stress has a very important role in atherogenesis.