Atherosclerosis is characterized by an accumulation of smooth muscle cells and a buildup of lipid-rich foamy macrophages within the arterial wall, which can lead to lumen narrowing and reduced blood flow or to a complete arterial blockage after plaque rupture.1 Atherosclerosis development is influenced by several factors, including age, sex, cholesterol level, and obesity.2 Despite the systemic nature of these risk factors, atherosclerotic plaque formation is remarkably localized, forming predominantly around arterial branches and the inner curvature of bends. Blood flow is a major influence on localized atherosclerosis development, because the location of plaques correlates with specific flow patterns.3 Regions of the artery wall where blood flow is low or disturbed are prone to atherosclerosis, whereas arterial regions exposed to high flow are protected. 4 Flow affects molecular transport from the bloodstream to the endothelium, because different flow conditions directly influence the local concentration of molecules and their interaction time with the artery wall. In addition to modifying mass transport, blood flow exposes the endothelial layer to wall shear stress (WSS; the friction-like drag between the fluid and the arterial wall surface) and other mechanical actions.5 Flowinduced WSS varies over time in both magnitude and direction in a characteristic pattern that is dependent on the location within the arterial system (Figure 1). 6,7 There are several metrics that can be used to characterize a stress pattern (Figure 1), including time-averaged WSS magnitude, oscillatory shear index (a figure of merit describing the fraction of the profile that the instantaneous WSS opposes the mean WSS direction during one oscillation), angular direction of shear stress, and harmonic frequency components. There is ongoing debate on the relative importance of these parameters in endothelial responses to WSS; however, it is plausible that mechanoreceptors integrate multiple mechanical parameters to convert information on WSS magnitude, frequency, and direction into biochemical signals. 8 Although many interrelated signaling networks have been identified, understanding of mechanically triggered signaling is still developing. Here, we review established, biochemically triggered, inflammatory mechanisms before discussing recent progress in uncovering the role of mechanical cues in inflammatory pathways and possible future directions of research. Please see http://atvb.ahajournals.org/site/misc/ ATVB_in_Focus.xhtml for all articles published in this series.
Blood Flow and Vascular InflammationAtherosclerosis is promoted by the recruitment of monocytes from the blood to the vessel wall via interactions with © 2014 American Heart Association, Inc. Abstract-Atherosclerosis is a chronic inflammatory disease of arteries that develops preferentially at branches and bends that are exposed to disturbed blood flow. Vascular function is modified by flow, in part, via the generation of mechanical forces that alter multiple physiological ...