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Atherosclerosis is a slow and progressive disease that may start in childhood. It is initiated by an accumulation and subsequent oxidation of low-density lipoprotein (LDL) in the arterial intima. The oxidized LDLs stimulate a series of events similar to inflammation. Macrophages (converted from monocytes) are recruited to ingest oxidized LDL, producing foam cells. Then T lymphocytes, platelets and smooth muscle cells also join foam cells, expanding the plaque size.
Since LDL is the origin of atherosclerosis and its complications, the cholesterol carried by LDL is often called bad cholesterol. By contrast, high-density lipoprotein (HDL) has many properties that can prevent atherosclerosis. The cholesterol carried by HDL is called good cholesterol.