This review integrates the mechanistic chain, from endothelial dysfunction and retention/oxidation of apolipoprotein B lipoproteins to maladaptive innate and adaptive immunity, failed efferocytosis with necrotic core expansion, and biomechanical forces that thin and fatigue the fibrous cap, with their corresponding <i>in vivo</i> imaging phenotypes. This evidence concerns the gene APOB and endothelial dysfunction.