Pathogenesis of atherosclerosis and plaque rupture
How apoB lipoproteins, endothelial dysfunction and inflammation build a plaque, why plaques form at branch points, what makes a plaque rupture or erode, how stenosis severity relates to flow, and the inflammation trials (CANTOS, COLCOT, LoDoCo2) that the exam uses.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Atherosclerosis is a chronic inflammatory disease of large and medium arteries, started by retention of apoB lipoproteins in the intima.
- LDL is causal: genetic, Mendelian randomisation and trial evidence all show risk rises with cumulative LDL exposure (EAS consensus, 2017).
- Sequence: endothelial dysfunction → LDL retention and oxidation → monocyte entry → foam cells (fatty streak) → smooth muscle migration and fibrous cap → necrotic core → rupture or erosion → thrombosis.
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Sources
- Robbins and Cotran Pathologic Basis of Disease, 10th editionElsevier (Kumar V, Abbas AK, Aster JC), 2021
- Braunwald's Heart Disease, 12th editionElsevier (Libby P, Bonow RO, Mann DL et al.), 2022
- Ference BA, Ginsberg HN, Graham I et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society. Eur Heart J 2017;38:2459-72European Heart Journal, 2017
- Ridker PM, Everett BM, Thuren T et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease (CANTOS). N Engl J Med 2017;377:1119-31New England Journal of Medicine, 2017
- Nidorf SM, Fiolet ATL, Mosterd A et al. Colchicine in patients with chronic coronary disease (LoDoCo2). N Engl J Med 2020;383:1838-47New England Journal of Medicine, 2020
- Tardif JC, Kouz S, Waters DD et al. Efficacy and safety of low-dose colchicine after myocardial infarction (COLCOT). N Engl J Med 2019;381:2497-505New England Journal of Medicine, 2019
- Jolly SS, d'Entremont MA, Lee SF et al. Colchicine in acute myocardial infarction (CLEAR SYNERGY). N Engl J Med 2025;392:633-42New England Journal of Medicine, 2025
- Glagov S, Weisenberg E, Zarins CK et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316:1371-5New England Journal of Medicine, 1987
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy