Neovascularization Of Coronary Tunica Intima (DIT) Is The Cause Of Coronary Atherosclerosis. Lipoproteins Invade Coronary Intima Via Neovascularization From Adventitial Vasa Vasorum, But Not From The Arterial Lumen A Hypothesis

This research paper challenges the traditional understanding of how coronary artery disease develops. The conventional theory suggests that heart disease begins when the inner lining of coronary arteries becomes damaged by inflammation and high LDL cholesterol ("bad cholesterol"), allowing cholesterol and immune cells to enter the artery wall from the bloodstream and form dangerous plaques.

However, this researcher proposes a different mechanism. He argues that coronary artery disease actually starts when new, abnormal blood vessels grow into the normally vessel-free middle layer of the coronary artery wall. These new vessels sprout from the tiny blood vessels (called vasa vasorum) that normally supply only the outer layer of the artery. When this happens, cholesterol-carrying particles can enter the artery wall through these new vessels rather than from the main blood channel inside the artery.

The evidence supporting this theory includes the observation that in diseased arteries, cholesterol deposits first appear in the outer portions of the artery wall, not the inner portions closest to the main bloodstream as the traditional theory would predict. The researcher also notes that a protein called biglycan, which strongly attracts cholesterol, is located in the outer layer where these deposits occur. In healthy arteries, this protein can't interact with cholesterol because there are no blood vessels in that area, but when abnormal vessels grow in, direct contact becomes possible.

This alternative explanation for coronary artery disease could help explain why some people develop heart disease despite having lower cholesterol levels, and why current treatments focused solely on cholesterol reduction have shown limited progress in recent years. For clinical practice, this research suggests that preventing or treating the abnormal blood vessel growth in artery walls might be as important as managing cholesterol levels, though more research would be needed to develop such treatments.