A review of 117 research publications describes a deficiency in fatty acid transport into intracellular oxidative energy metabolism which causes increased fibrinogen synthesis and turnover into fibrin. The increased production of fibrin, coupled with depressed activation of plasminogen, increases the fibrin/plasmin ratio causing thrombosis-induced atherogenesis. This discovery unifies the two schools of atherogenesis based on blood lipid or fibrin deposition theories.