Beyond the plaque: immunological implications of risk factors in atherosclerosis

Óscar R. Aguilar-Villegas, Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México
Javier Barragán-Los Santos, Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México
Luis E. Del Moral-Wong, Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México
Luis M. Amezcua-Guerra, Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México
Ma. Magdalena Aguirre-García, Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México

The formation of atherosclerotic plaque results from the complex interaction between modifiable and non-modifiable risk factors, through immune mechanisms that orchestrate both inflammatory and anti-inflammatory processes. Atherosclerosis often culminates in ischemic heart disease or cerebrovascular events, which are the leading causes of mortality worldwide. Currently, primary prevention focuses on controlling modifiable risk factors. Therefore, understanding the molecular mechanisms underlying the damage induced by these risk factors is essential to develop more effective treatments. This article provides a detailed review of the immunological processes underlying the initiation and progression of atheroma plaque, exploring their relationship with traditional risk factor such as smoking, diabetes mellitus, dyslipidemia, and hypertension, as well as a new potential risk factor: microbiota dysbiosis. Furthermore, the attributable risk of each factor is independently assessed, and the effectiveness of risk factor control measures is demonstrated as the best strategy to date for the regression of atherosclerosis and the prevention of its complications.

Keywords: Atherosclerosis. Risk factors. Primary prevention. Immunity. Atherosclerotic plaque.