What is the primary layer of the artery where atherosclerosis begins?

Atherosclerosis primarily begins in the intima, which is the innermost layer of the artery. This layer is in direct contact with the blood flow and is composed of endothelial cells, subendothelial connective tissue, and smooth muscle cells. The intima plays a crucial role in vascular health and disease, as it is here that factors such as high cholesterol levels and inflammation can lead to endothelial dysfunction.

As atherosclerosis develops, lipids accumulate within the intima, leading to the formation of fatty streaks and subsequently more complex lesions, including plaques that can narrow the artery and impede blood flow. This process is a key aspect of cardiovascular disease and is critical for vascular specialists to understand when assessing and managing patients at risk.

The other layers, such as the adventitia (outer layer) and the media (middle layer), are involved in the structural integrity and function of the vessel but do not play a direct role in the initiation of atherosclerosis.