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Published on: January 13, 2012

Hemodynamic shear stress and its role in atherosclerosis

A M Malek1, S L Alper, S Izumo

  • 1Neurosurgery, Brigham and Women's Hospital and Children's Hospital, Boston, Mass 02115, USA. ammalek@bics.bwh.harvard.edu

JAMA
|December 11, 1999
PubMed

Insights

Atherosclerosis, a major cause of death, is linked to low hemodynamic shear stress at vessel bifurcations. This low shear stress promotes an atherogenic phenotype, contributing to the disease's focal nature.

Area of Science:

  • Cardiovascular Biology
  • Biomedical Engineering
  • Pathophysiology

Background:

  • Atherosclerosis is a leading cause of mortality globally.
  • It is associated with systemic risk factors like hypertension, smoking, hyperlipidemia, and diabetes mellitus.
  • Despite systemic factors, atherosclerosis exhibits focal predilection, particularly at vessel bifurcations.

Purpose of the Study:

  • To investigate the role of hemodynamic shear stress in the focal development of atherosclerosis.
  • To understand how shear stress influences endothelial function and phenotype at different arterial sites.

Main Methods:

  • Review of studies examining endothelial function in relation to blood flow patterns.
  • Analysis of shear stress levels at atherosusceptible versus atheroprotected arterial regions.
  • Correlation of shear stress with endothelial gene expression profiles.

Main Results:

  • Low shear stress (<4 dyne/cm2) is prevalent at atherosclerosis-prone sites, such as vessel bifurcations.
  • Low shear stress stimulates an atherogenic endothelial phenotype.
  • High shear stress (>15 dyne/cm2) induces endothelial quiescence and an atheroprotective gene expression profile.

Conclusions:

  • Hemodynamic shear stress is a critical determinant of endothelial phenotype and function.
  • Local variations in shear stress explain the focal nature of atherosclerosis, even with systemic risk factors.
  • Understanding shear stress mechanisms may inform novel therapeutic strategies for atherosclerosis.

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