The central role of the endothelium in VOC and atherosclerosis. This image portrays the endothelium as the first line of defense against multiple injurious stimuli. Most of the injurious stimuli are represented by the A-FLIGHT-U toxicities found in table 3. When discussing the role of VOC and how it ties into atherosclerosis and the accelerated ASO associated with metS, prediabetes, and overt T2DM it is important to include the various interactions of A-FLIGHT-U toxicities with the associated ROS and the sensitizers for calcium deposition and ossification (Ca++, Pi, PTH) within the AVW (both the media and intima) in table 5. The role of ROS, inflammation monocyte-macrophage foam cells undergoing apoptosis – necrosis with creation of a nidus and the stimuli for the VSMC and pericyte following the neovascularization (Vv) of the media and intima to result in osteoid formation and later the mineralization within these atherosclerotic plaques. This image also portrays the possible role for nanobacteria in addition to C. pneumonia as well as other bacteria and viral infections as possible contributing factors for the ossification process.