Haemodynamics and arterial wall metabolism: their possible combined role in atherogenesis

An integrated model for the genesis of atherosclerosis is proposed on the basis of the evidence reported in the literature from the fields of haemodynamics and arterial wall metabolism. The model is based on the hypothesis of 'localized nutrient shortage' in the arterial wall at critical regions of the vascular tree, such as branchings, bendings, stenosis etc. In particular, it is proposed that a tissue deficit of glucose and oxygen, more pronounced at those regions, may be the main cause of endothelial dysfunction and lesion initiation. LDL-cholesterol level and hypertension are included as strongly interacting risk factors, and new explanations are provided for the effects of smoking and diabetes. For the latter factors, transport limitations in the lumen and/or in the tissue are likely to interact with wall metabolism; in the case of smoking, additional competition of CO and O2 within the tissue is suggested, and for diabetes, the impaired uptake of glucose by the tissue is proposed as the main causal factor. Also, the incorporation of secondary risk factors to the model is shown to be feasible on the basis of their suggested action mechanism. It is concluded that the study of nutrients and LDL transport at regions of complex arterial geometry in connection with wall metabolic requirements can provide a better understanding of the atherogenic process.