Clinicians are accustomed to thinking about atherosclerosis as a linear process — a slow, relentless accumulation of plaque that progresses toward an inevitable clinical event. This model is intuitive but incomplete. The biological reality of atherosclerosis is not a straight line but a wave — a repeating cycle of inflammatory activation, tissue injury, repair, and relative quiescence that operates simultaneously at the level of individual plaques, the arterial system as a whole, and the patient's systemic inflammatory state. Recognising this cyclicity is not merely an academic refinement. It has direct consequences for how clinicians time interventions, interpret symptom patterns, and anticipate acute events. Damage and repair as a repeating unit At the level of the individual plaque, atherosclerosis is best understood as a chronic wound that never fully heals. Each episode of cap erosion or rupture initiates a reparative inflammatory response — progenitor cells are recruited, a p...
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