Atherosclerosis is the outcome of adaptive complexity in the Arterial Endothelial Microenvironment

Atherosclerosis, described by plaque development in large arteries, was traditionally perceived to be regulated by systemic factors including hypertension and hypercholesterolemia. However, recent studies have established that plaque development and progression are characteristically determined by an intricate coordination between both systemic and local cues. A large array of studies on the local endothelial microenvironment suggests that in addition to the biochemical dynamics, arterial mechanics, and the crosstalk between extracellular matrix and endothelium play a fundamental role in athero-inflammation and athero-progression. Ongoing inflammatory processes in the endothelial microenvironment appears to be initially adaptive but ultimately becomes maladaptive, leading to pathophysiological complications and unresolved plaques. In this review, we will be discussing how the essential components of the local arterial microenvironment interact among themselves and how any abnormality in this microenvironment might be responsible for atherosclerosis pathogenesis.