Vasa vasorum hypoxia: initiation of atherosclerosis.

We propose a new hypothesis pointing of a functional hypoxia in vasa vasorum, which might explain the initiation and the early development of the atherosclerosis in the deep layer of intima. Since vasa vasorum are end arteries, they easily develop hypoxia and/or ischemia in the cells of intima or media of arterial wall. The most vulnerable sites for hypoxia are the arterial bifurcations due to the anatomical and physiological reasons. They are also known to be the most common sites of atherosclerosis. The known risk factors for atherosclerosis, high blood pressure and nicotine, reduce the blood flow in the end branches of the vasa vasorum. The local ischemia will affect the endothelial cell structure and causes a local inflammation, which, in turn, makes it permeable to large particles such as microbes and LDL-lipoproteins and other fatty acids, which are phagocytozed by macrophages transforming them into foam cells. The present hypothesis explains most problems of the previous theories and offers a logical sequence of the events involved in the development of atherosclerosis.