Our familiarity with atherosclerosis obscures a perplexing paradox that challenges our conventional understanding of disease initiation and progression: Most risk factors for atherosclerosis are systemic, yet the disease is focal in nature. For example, all vessels bath in the same metabolic milieu and are uniformly exposed to the untoward effects of hypertension. Yet, atherosclerosis involves arteries segmentally and affects different arterial beds unequally. Specifically, atherogenesis tends to spare the internal mammary artery (IMA), while the neighbouring and similarly sized coronary arteries bear the brunt of atherosclerosis. What protects the IMA from atherogenesis? Check out the review article by Kraler and Libby et al. on possible mechanisms, now up ATVB.