THE RÔLE OF THE LIPIDS IN ATHEROSCLEROSIS

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Abstract
Chemical, physical and morphologic changes occur in arteries with age. These changes seem to be independent of atherosclerosis which is primarily a disease of the intima. The simple fatty deposits with atherosclerosis have the same lipid composition as the blood plasma and the normal intima. The identical composition of these tissue lipids strongly supports the view that the lipid deposits in artherosclerosis result from a non-selective deposition of the plasma lipids. Although cholesterolemia may favor the development of atherosclerosis, the lesions of this vascular disorder develop in adult life without an appreciable elevation of the blood cholesterol or obvious abnormality of the blood lipids. This suggests that factors in the tissues of the blood vessels leading to the deposition of lipids in the intima are important in the causation of the disease. The tissue factors concerned with the localization of the lipid deposits in the intima are not known. However, after the lipids are deposited and remain in the tissues in coarse particulate form, the subsequent stages of atherosclerosis follow. The evolution of the lesions from the simple fatty deposits to calcified atheromatous ulcers occurs because of several processes; among which are phagocytosis, physical or chemical effects on the tissues by the lipids or their decomposition products, disturbances in nutrition of the tissues, admixtures of blood, and reactions of the tissues against the lipids deposited. The calcification which occurs late in the evolution of the lesions probably is the same as that which develops in any necrotic or devitalized tissue of the body. The evidence presented in this review favors the conclusion that atherosclerosis develops from disturbances in the metabolism of lipids infiltrated into the tissues of the intima. The elucidation of the nature of the disturbances, however, depends upon further fundamental studies on the interactions and interconversions of the lipids in the blood and tissues.

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