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Atherosclerosis is the primary underlying cause of coronary heart disease (CHD), the most common source of mortality in the industrial world. Its natural history and disease associations have been extensively studied, but the actual etiology remains unknown. Hypertension, smoking, diabetes, hyperlipidemia, and a positive family history are identified disease associations, but cannot account for all cases of CHD. Progressive plaque development in atherosclerosis leads to arterial stenosis, which is characterized clinically by angina and may eventually lead to unstable angina, myocardial infarction, and cardiac death. The presence of lipid particles (especially cholesterol) in the blood and chronic inflammation at the site of endothelial injury contributes to the initiation, growth and disruption of atherosclerotic plaque. A variety of therapies for the prevention of atherosclerosis have been developed that are moderately effective. These include lipid lowering agents, antiplatelet agents, Renin Angiotensin Aldosterone System (RAAS) inhibitors, and anti-inflammatory agents. However, many of these agents result in intolerable side effects and despite their widespread use, atherosclerosis remains a major cause of death in most of the world. Other approaches for therapy or prevention are needed.
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