Endothelial dysfunction is the first step of this process, which involves some important events including: upregulation of adhesion molecules (E-selectin, vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), etc.)leading to recruitment and attachment of circulating monocytes which progressively accumulate low density lipoprotein (LDL) particles and are later oxidized. Here, VCAM1 is linked to endothelial dysfunction.