Quo vadis, atherogenesis? Part 2. Tunica adiposa-the new player in the process of atherogenesis

Today, atherosclerosis is considered an immune-mediated inflammatory disease featured by endothelial dysfunction (intimal thickening), medial atrophy, and adventitial lesions associated with adipose dysfunction. Since Rudolf Virchow's time when the intima has been considered the most important vascular area involved in atherogenesis, our views on this multiplex phenomenon are indeed changing. Here we Dance round an emerging role played by perivascular adipose tissue (tunica adiposa) in the process of atherogenesis. We intend to integrate the traditional "inside-out"(intimal and medial) to an "outside-in"(adventitial and adipose) pathway of atherogenesis.