Darwinian evolution and cardiovascular remodeling.

Mechanotransduction, MT, is an ancient evolutionary legacy existing in every living species and involving complex rearrangements of multiple proteins in response to a mechanical stress. MT includes three different interrelated processes: mechanosensation, mechanotransmission, and mechanoresponse. Each process is specifically adapted to a given tissue and stress. Both cardiac and arterial remodeling involve MT. Physiological or pathological cardiac remodeling, CR, is firstly a beneficial mechanoresponse, MR, which allows the heart to recover to a normal economy, better adapted to the new working conditions. Nevertheless, exercise-induced cardiac remodeling is more a coming-back to normal conditions than a superimposed event. On the longer term, the MR creates fibrosis which accounts, in part, for the reduced cardiac output in the CR. In the hypertension-induced arterial remodeling, arterial MR allows the vessels to maintain a normal circumferential constraint before an augmented arterial pressure. In atherogenesis: (i) The presence of atheroma in several animal species and atherosclerosis in ancient civilizations suggests more basic predispositions. (ii) The atherosclerotic plaques preferably develop at predictable arterial sites of disturbed blood flow showing that MT is involved in the initial steps of atherogenesis.