Vascular disease and inflammation

Atherosclerosis, one of the most common diseases, remains one of the leading causes of death in Western societies. Many of the features of atherosclerosis, including the first signs of atherosclerosis (the fatty streak in the intima of the arterial wall, the atherosclerotic plaque, and the plaque rupture) have many characteristics of chronic inflammation. Newer data suggest that atherosclerosis is a chronic inflammatory process involving markers of inflammation such as C-reactive protein, plasminogen activator inhibitor-1, monocytes, macrophages, and T lymphocytes. Homocysteine, oxidized LDL, remnant lipoprotein (very low-density lipoprotein), and lipoprotein(a) are all believed to play secondary roles as proinflammatory agents. Chronic infection with Chlamydia spp., cigarette smoking, and hyperglycemia are all believed to be involved in the process through inflammatory mechanisms. Recognition that dyslipidemia and chronic inflammation have important roles in the development of atherosclerosis have led to multiple new therapies that are decreasing disease burden, decreasing the number of cardiovascular events, and improving quality of life and longevity.