Arterial atherosclerosis is the main pathological cause of coronary artery disease and peripheral
arterial disease. Atherosclerosis is a chronic condition characterized by the presence of
cholesterol-rich macrophages in the arterial intima. Accumulation of cholesterol in these
macrophages is due to increased oxidation of low-density lipoprotein (LDL) and its uptake via scavenger
receptors on the macrophages. Cholesterol efflux from the cholesterol-laden macrophages into
high-density lipoprotein (HDL) is also a key process in maintaining cholesterol homeostasis and
preventing cholesterol accumulation. Four pathways for the efflux of cholesterol to HDL exist in
macrophages, including passive and active pathways. Several HDL characteristics determine
cholesterol efflux capacity, namely composition, oxidative status, and HDL size. Oxidation of LDL
and HDL, as well as an imbalance in cholesterol uptake and efflux, could lead to the accumulation
of cholesterol in macrophages and initiation of atherosclerogenesis.
Epidemiological studies have demonstrated that polyphenol-rich foods reduce cardiovascular
events in the general population and in patients at risk of cardiovascular diseases. Many studies
have reported that polyphenols in polyphenol-rich foods have anti-atherosclerotic properties by preventing
cholesterol accumulation in macrophages through the suppression of lipoproteins oxidation
and regulation of cholesterol uptake and efflux.
Keywords: Atherosclerosis, cardiovascular disease, polyphenols, low-density lipoprotein, high-density lipoprotein, oxidation
of lipoproteins, cholesterol efflux capacity, ATP-binding cassette (ABC) transporters, macrophage cholesterol metabolism.
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