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Atherosclerosis is implicated as playing the key role in the pathogenesis of cardiovascular diseases involving large and medium sized arteries. There is now evidence that atherosclerosis is an immuno- inflammatory process. Chronic psychosocial stress is the main trigger for the systemic inflammation which results by activation of hypothalamus-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) axis. This stress response sets into motion innate immune response, initiating a cascade of events which include: release of neuro-endocrine transmitters, endothelial dysfunction, increased permeability of micro vascular circulation and increased delivery of free fatty acids in circulation among others. Liver responds by increasing low density lipoproteins production which continuously enter the arteries, excess of LDL is transformed into oxidized low density lipoproteins (ox LDL).
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