Mechanisms involved in extracellular matrix remodeling and arterial stiffness induced by hyaluronan accumulation.

•Hyaluronan (HA) accumulation in the tunica media is an indirect cause of arterial stiffness.•HA accumulation in the tunica media prepares the vascular bed for calcification.•HA accumulation in the tunica media induces a shift in smooth muscle cell phenotype towards higher proliferation.•HA accumulation in the tunica media increases the amount of heavy chain (HC)-HA complexes thereby increasing the extracellular matrix' affinity for leukocytes.•HA accumulation in the tunica media creates an atherosclerosis prone artery.