Abstract / Summary
Atherosclerotic plaque calcification is a complex and actively regulated process involved in the progression and structural remodeling of atherosclerotic lesions. Current evidence indicates that vascular calcification is not merely a passive consequence of tissue degeneration but involves coordinated cellular and molecular mechanisms. Vascular smooth muscle cells (VSMCs) play a central role by undergoing osteogenic and chondrogenic phenotypic transformation, associated with activation of the BMP/SMAD/RUNX2 and Wnt/β-catenin signaling pathways. Chronic inflammation, oxidative stress, extracellular matrix remodeling, and disturbances in mineral metabolism further promote osteogenic transformation and calcium-phosphate deposition. The biological effects of calcification depend on its morphology, size, and distribution within the plaque. Microcalcifications may increase local mechanical stress and contribute to plaque vulnerability, whereas larger consolidated calcifications may exert different structural effects. This review summarizes the current understanding of atherosclerotic plaque calcification, focusing on VSMC osteogenic transformation and major osteogenic signaling pathways.