Atherosclerosis as a paradigmatic disease of the elderly: role of the immune system

Clinically overt atherosclerosis is considered a paradigmatic disease of the elderly. Postmortem pathohistological evaluation of the arteries of children and young adults who died from noncardiovascular diseases, as well as in vivo sonographic assessment of the intima media thickness of young adults clearly show that the first alterations in the arterial wall can already be found at this age. During the past few years the authors have put forward a new immunologic hypothesis for the development of atherosclerosis. In principle, this concept states that the first stage of the disease is of an immunologic-inflammatory nature that is caused by an autoimmune reaction against stress proteins (heat shock protein 60) expressed by arterial endothelial cells as a consequence of the action of stress factors (ie, classical atherosclerosis risk factors). If these risk factors are not eliminated, the progression of atherosclerosis, by way of fatty streaks, to severe plaques occurs.