The mechanistic relationships between hemorheological characteristics and cardiovascular disease

Area of Science:

• Cardiovascular Science
• Biomedical Engineering
• Rheology

Background:

• Traditional atherogenesis research focused on biochemical factors and vessel wall histology.
• Atherosclerosis is recognized as a sterile process initiated by endothelial dysfunction, but the cause of initial injury remains unclear.
• The 'biochemical' approach has limitations in fully explaining the complex atherogenic process.

Purpose of the Study:

• To propose a paradigm shift in understanding atherogenesis from a biochemical to a biomechanical perspective.
• To identify mechanical injury related to the work of the heart (WOH) as the initiating event in atherosclerosis.
• To highlight the role of blood rheology, particularly whole blood viscosity (WBV), in the development of atherosclerosis.

Main Methods:

• Review and synthesis of existing literature on atherogenesis, endothelial function, and cardiovascular risk factors.
• Presentation of evidence linking mechanical injury, blood rheology, and endothelial response.
• Discussion of the implications of a biomechanical model for understanding atherosclerosis.

Main Results:

• The study proposes that mechanical injury to the arterial endothelium, driven by changes in blood rheology, initiates atherosclerosis.
• Elevated whole blood viscosity (WBV) is independently correlated with increased carotid intima-media thickness and major cardiovascular disease risk factors.
• Increased WBV is suggested as a unifying factor linking various cardiovascular risk factors and the development of atherosclerosis.

Conclusions:

• Atherosclerosis development can be better understood through a biomechanical lens, focusing on mechanical stress and blood flow dynamics.
• Blood rheology, particularly whole blood viscosity, is a critical and potentially overlooked factor in cardiovascular disease.
• Advancements in rheometry, such as the scanning capillary rheometer, facilitate accurate study of blood rheology, supporting the biomechanical hypothesis.