Figure 5.

Formation of a Vicious Pathogenetic Circle Integrating Atherogenesis and its Critical Complications. Note: This figure illustrates the development of a vicious pathogenetic circle integrating atherogenesis and its critical complications associated with acute and chronic systemic hyperinflammation. (1) The development of atherosclerosis is closely related to tissue aging, metabolic allostasis, and systemic and local low-grade inflammation. (2) Complications related to atherosclerosis can lead to systemic alteration, which is essential for the development of systemic hyperinflammation. (3) The development of acute or chronic systemic inflammation leads to more pronounced changes in homeostasis than low-grade inflammation, including in arteries that are problematic in relation to atherosclerosis, which in turn increases the likelihood and severity of critical complications. (4) In sepsis, severe trauma, various shock conditions, as well as in systemic autoimmune diseases, end-stage renal disease, and some other severe chronic diseases, systemic hyperinflammation may occur primarily in relation to progressive atherosclerosis. However, in this case, systemic inflammation will also provoke the accelerated development of atherosclerosis and the subsequent formation of a negative feedback loop.