Hemodynamic Bigger Hydrostatic Pressure Instead of Lower Shear Stress Aggravates Atherosclerosis

TL;DR

This paper proposes that increased hydrostatic pressure, rather than low shear stress, is the key factor aggravating atherosclerosis, based on Bernoulli's equation and blood flow dynamics.

Contribution

It introduces a novel perspective that hydrostatic pressure, derived from blood velocity changes, plays a central role in atherogenesis, challenging traditional shear stress theories.

Findings

Hydrostatic pressure increases as blood velocity decreases.

Areas with lower blood velocity have higher hydrostatic pressure, promoting atherosclerosis.

This mechanism explains the predilection sites for atherosclerosis.

Abstract

The traditional view is that low shear stress of blood flow accelerates atherosclerosis. How does a low shear stress damage the vessel or aggravate atherosclerosis? It is a puzzling question. Furthermore, shear stress of veins is similar to that of Relatively Vulnerable Zones (RVZ) of arteries, while intimal thickening of veins is not obvious as the arteries. There are many places in arterioles with lower shear stress as the decrease of blood velocity, while the thickening of arterioles is not as obvious as that of the medium-sized arteries. These issues make it unconvincing for us to explain atherogenesis with lower shear stress. According to Bernoulli fluid equation (P+1/2\r{ho}v^2+\r{ho}gh=constant), in a closed pipe full of flowing blood, at the same height, the hydrostatic pressure is inversely proportional to the second power of blood velocity. At any point of per unit mass of fluid micro cluster here, the reduction of 1/2\r{ho}v^2 would be converted into P. Therefore, hydrostatic pressure(P) is inversely proportional to v^2 in a very short distance or in the same transection of the artery. When blood micro cluster flows over a very short distance or the same transection of the artery, previous studies did not consider the conversion between 1/2\r{ho}v^2 and P. Therefore, low shear stress aggravates atherosclerosis is an appearance, and the essence is that these areas with smaller blood velocity have much bigger hydrostatic pressure, which aggravates atherosclerosis. This perfectly explains the predisposing sites of atherosclerosis.