Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Clin Hemorheol Microcirc. 2024;88(2):277-288. doi: 10.3233/CH-242128.
Endothelial dysfunction, the earliest manifestation of atherosclerosis, can be initiated by both biochemicals and biomechanical forces. Atherosclerosis occurs predominantly at arterial branch points, arterial bifurcations and the curved segments of great arteries. These are the regions that blood flows turbulently. Turbulence promotes endothelial dysfunction by reducing shear stress upon endothelial cells. The endothelial glycocalyx mediates the effect of shear stress upon the endothelium. A mathematical analysis of cardiovascular hemodynamics demonstrates that fluid retention increases turbulence of blood flow. While there is no empirical data confirming this relationship, fluid retention is associated with adverse cardiovascular events. Every medical condition that causes fluid retention is associated with increased risk of both atherosclerotic cardiovascular disease and venous thromboembolic disease. In addition, most medications that cause fluid retention are associated with increased adverse cardiovascular effects. Calcium channel blockers (CCBs) and pioglitazone are exceptions to this generalization. Even though data regarding CCBs and pioglitazone contradict the hypothesis that fluid retention is a cardiovascular risk factor, these medications have favorable cardiovascular properties which may outweigh the negative effect of fluid retention. Determining whether or not fluid retention is a cardiovascular risk factor would require empirical data demonstrating a relationship between fluid retention and turbulence of blood flow. While this issue should be relevant to cardiovascular researchers, clinicians and patients, it is especially pertinent to the pharmaceutical industry. Four-dimensional magnetic resonance imaging and vector flow Doppler ultrasound have the capability to quantify turbulence of blood flow. These technologies could be utilized to settle the matter.
内皮功能障碍是动脉粥样硬化的最早表现，它可以由生化物质和生物力学因素共同引发。动脉粥样硬化主要发生在动脉分支点、动脉分叉处和大动脉的弯曲段。这些部位是血液流动不稳定的区域。血流的不稳定性通过降低内皮细胞的切应力来促进内皮功能障碍。内皮糖萼介导切应力对内皮的影响。心血管血液动力学的数学分析表明，流体潴留会增加血流的不稳定性。虽然没有经验数据证实这种关系，但流体潴留与不良心血管事件有关。引起流体潴留的每一种医学状况都与动脉粥样硬化性心血管疾病和静脉血栓栓塞性疾病风险增加有关。此外，大多数导致流体潴留的药物都与增加不良心血管影响有关。钙通道阻滞剂（CCB）和吡格列酮是这种概括的例外。尽管关于 CCB 和吡格列酮的数据与流体潴留是心血管危险因素的假设相矛盾，但这些药物具有有利的心血管特性，可能超过流体潴留的负面影响。确定流体潴留是否是心血管危险因素需要有经验数据证明流体潴留与血流不稳定性之间存在关系。虽然这个问题应该与心血管研究人员、临床医生和患者有关，但它与制药行业尤其相关。四维磁共振成像和向量流多普勒超声有能力定量血流不稳定性。这些技术可以用来解决这个问题。
