An Etiologic Concept of Atherosclerosis Based on Study of Intimal Alterations after Shock

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Abstract
On the basis of analysis of the bibliography of animal experiments and of anatomic observations on autopsy and surgical material from infants and adolescents who experienced shock, a new concept of atherogenesis is formed. Changes in osmotic pressure, plasmatic dyscolloidity and hypoalbuminemia cause hydropic swelling of the intimal endothelial cells followed by increased permeability. Seepage of plasma through injured endothelium results in edema and hyaline-mucoid change of the subintimal ground substance. Lipoproteins are broken down and most of the foreign matter is resorbed. Lipids, namely cholesterol, remain in the subintima, act as irritants and initiate the alterations known as atherosclerosis.