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What Is the Best Strategy for Reducing Deaths from Heart Disease?

  • Michael E Makover,
  • Shah Ebrahim
  • Published: April 26, 2005
  • DOI: 10.1371/journal.pmed.0020098

Reader Comments (3)

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Turbulence and Mixing may explain Atherosclerosis

Posted by plosmedicine on 30 Mar 2009 at 23:43 GMT

Author: Lewis Coleman
Position: MD/Anesthesiologist
Institution: Semi-Retired
E-mail: lewiscoleman@bak.rr.com
Submitted Date: June 19, 2005
Published Date: June 21, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

I have followed the informative exchange of Drs. Makeover and Ebrahim. Both atherosclerosis and coagulation may be related to turbulence and mixing.1,2 Present theory attributes atherosclerosis to inadequate shear stress, which is consistent with the acceleration of atherosclerosis along the greater curvature of arteries, and factors which impair or enhance cardiac dynamics, such as myxedema and exercise.3 Shear Stress is directly related to turbulence and mixing. However, shear stress is little affected by viscosity, whereas turbulence and mixing are inversely proportional to viscosity. The shear stress hypothesis fails to explain factors that simultaneously affect viscosity and atherosclerosis, where shear stress remains normal. Examples include anemia4 and moderate alcohol consumption5, which reduce viscosity and retard atherosclerosis, contrasted with elevated fibrinogen6, diabetes7, Systemic Lupus Erythematosis8, and polycythemia9 that increase viscosity and accelerate atherosclerosis.
I hypothesize that atherosclerosis is caused by inadequate levels of turbulence and mixing that enable blood components to escape suspension and deposit on arterial walls. If so, the most effective approach to preventing and treating atherosclerosis may be measures that reduce viscosity and/or improve cardiac dynamics. Ultrasound might offer an effective means of treatment as well as diagnosis.

1. Coleman LS: Insoluble Fibrin may reduce turbulence and bind blood components into clots (in press). Medical Hypotheses 2005
2. Hof B, van Doorne CW, Westerweel J, Nieuwstadt FT, Faisst H, Eckhardt B, Wedin H, Kerswell RR, Waleffe F: Experimental observation of nonlinear traveling waves in turbulent pipe flow. Science 2004; 305: 1594-8
3. Malek AM, Alper SL, Izumo S: Hemodynamic shear stress and its role in atherosclerosis. Jama 1999; 282: 2035-42
4. Tous M, Ferre N, Vilella E, Riu F, Camps J, Joven J: Circulating blood cells modulate the atherosclerotic process in apolipoprotein E-deficient mice. Metabolism 2004; 53: 95-100
5. Hoffmeister A, Imhof A, Rothenbacher D, Khuseyinova N, Brenner H, Koenig W: [Moderate alcohol consumption and plasma concentration of sensitive markers of inflammation. Comment on an atheroprotective relationship]. Dtsch Med Wochenschr 2003; 128: 2237-41
6. Stuart J, George AJ, Davies AJ, Aukland A, Hurlow RA: Haematological stress syndrome in atherosclerosis. J Clin Pathol 1981; 34: 464-7
7. Kensey KR: The mechanistic relationships between hemorheological characteristics and cardiovascular disease. Curr Med Res Opin 2003; 19: 587-96
8. Rosenson RS, Shott S, Katz R: Elevated blood viscosity in systemic lupus erythematosus. Semin Arthritis Rheum 2001; 31: 52-7
9. Cinar Y, Demir G, Pac M, Cinar AB: Effect of hematocrit on blood pressure via hyperviscosity. Am J Hypertens 1999; 12: 739-43

No competing interests declared.