Role of the endothelium in atherosclerosis

Endothelial injury has long been considered as a prerequisite for atherosclerotic plaque formation. Experimental and clinical studies have proven that during lesion development the endothelium is morphologically intact, but its phenotype is changed to an activated state, which favours the chronic inflammatory process leading to atherosclerotic disease. Endothelium is involved in atherosclerosis in several manners including: 1. subendothelial accumulation of atherogenic lipoproteins, through the barrier properties of the endothelium; 2. intimal accumulation of macrophages, through recruitment and adhesion of monocytes, when endothelial cells are activated; 3, vasospasm, when its vasodilatory properties are altered; 4, thrombus formation, when the endothelium is eroded.