THE YIN AND YANG OF OXIDATION IN THE DEVELOPMENT OF THE FATTY STREAK - A REVIEW BASED ON THE 1994 GEORGE-LYMAN-DUFF-MEMORIAL-LECTURE

Recent data support the hypothesis that the fatty streak develops in r esponse to specific phospholipids contained in LDL that become trapped in the artery wall and become oxidized as a result of exposure to the oxidative waste of the artery wall cells. The antioxidants present wi thin both LDL and the microenvironments in which LDL is trapped functi on to prevent the formation of these biologically active, oxidized lip ids. Enzymes associated with LDL and HDL (eg, platelet activating fact or acetylhydrolase) or with HDL alone (eg, paraoxonase) destroy these biologically active lipids. The regulation and expression of these enz ymes are determined genetically and are also significantly modified by environmental influences, including the acute-phase response or an at herogenic diet. The balance of these multiple factors leads to an indu ction or suppression of the inflammatory response in the artery wall a nd determines the clinical course.