Understanding the mechanism from which heart attack or ischemic stroke occurs allows for an appreciation of the connection between inflammation, disease and vascular events. Atherosclerotic plaque lesions develop silently within the artery wall, often with minimal luminal encroachment. When an artery wall weakens due to an influx of inflammation, the protective endothelial lining can rupture or erode, thus exposing the plaque to blood flow, creating the potential for thrombus formation. Not all plaque ruptures or erosions result in major CV events, some lead to progression of plaque volume or create microvessel thrombi that cause microvascular disease states such as silent heart attacks, silent strokes which contribute to vascular dementia and peripheral vascular disease. Regardless of the resulting effects of a thrombus, the presence of an atheroma is essentially a condition for an event.