Atherosclerotic plaques: is endothelial shear stress the only factor?

Initiation and development of atherosclerosis has largely been attributed to irregular shear stress patterns and values, in the current literature. Abnormalities such as low shear stress, reversing and oscillatory shear force patterns, as well as temporal variations of shear stress are the most cited factors. However, clinical findings have further indicated that plaques have still been formed and developed in arterial sites that possess relatively more steady and higher shear stresses than those observed in studies correlating low or oscillatory shear stresses with atherosclerosis. These data imply that deviations in shear stress from its normal physiological pattern alone may not be the only factor inducing atherosclerosis, and additional haemodynamics parameter other then shear stress may also contribute to the initiation and development of plaques. In this paper, we hypothesise that the combined effect of wall shear stress and circumferential stress waves, in the form of angular phase difference between the two waves at each cardiac cycle, may be a more accurate determinant of plaque formation and growth. Furthermore, arterial sites that possess more positive values of this angular phase difference may be more prone to plaque formation or development. If proved correct, this theory can transform our understanding of endothelial cell mechanotransduction and mechanobiology, and may lead to design and utilisation of new diagnostic procedures and equipment as predictive and preventive clinical tools for patients with abnormal arterial blood pressure.