title: Biomechanical factors in atherosclerosis: mechanisms and clinical implications.
abstract: Blood vessels are exposed to multiple mechanical forces that are exerted on the vessel wall (radial, circumferential and longitudinal forces) or on the endothelial surface (shear stress). The stresses and strains experienced by arteries influence the initiation of atherosclerotic lesions, which develop at regions of arteries that are exposed to complex blood flow. In addition, plaque progression and eventually plaque rupture is influenced by a complex interaction between biological and mechanical factors-mechanical forces regulate the cellular and molecular composition of plaques and, conversely, the composition of plaques determines their ability to withstand mechanical load. A deeper understanding of these interactions is essential for designing new therapeutic strategies to prevent lesion development and promote plaque stabilization. Moreover, integrating clinical imaging techniques with finite element modelling techniques allows for detailed examination of local morphological and biomechanical characteristics of atherosclerotic lesions that may be of help in prediction of future events. In this ESC Position Paper on biomechanical factors in atherosclerosis, we summarize the current 'state of the art' on the interface between mechanical forces and atherosclerotic plaque biology and identify potential clinical applications and key questions for future research.
authors.affiliation: Department of Pathology and Immunology, University of Geneva, CMU, Rue Michel-Servet 1, CH-1211 Geneva, Switzerland brenda.kwakchanson@unige.ch paul.evans@sheffield.ac.uk.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Kwak
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Bäck
authors.affiliation: University of Geneva, Geneva, Switzerland.
authors.forename: Marie-Luce
authors.initials: ML
authors.lastname: Bochaton-Piallat
authors.affiliation: Bichat Hospital, Paris, France.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Caligiuri
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mat J A P
authors.initials: MJ
authors.lastname: Daemen
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Davies
authors.affiliation: University Medical Center Urecht, Utrecht, The Netherlands.
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.affiliation: KU Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Holvoet
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Hanjoong
authors.initials: H
authors.lastname: Jo
authors.affiliation: Imperial College London, London, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Krams
authors.affiliation: McGill University, Montreal, QC, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lehoux
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Monaco
authors.affiliation: Ludwig-Maximilians-Universität (LMU), Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Steffens
authors.affiliation: CVPath Institute, Gaithersburg, MD, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Ludwig-Maximilians-Universität (LMU), Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Weber
authors.affiliation: ErasmusMC, Rotterdam, The Netherlands.
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Wentzel
authors.affiliation: Department of Cardiovascular Science, Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK brenda.kwakchanson@unige.ch paul.evans@sheffield.ac.uk.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Evans
mesh_terms: D017209:Apoptosis / Q000502:physiology; D001158:Arteries / Q000502:physiology*; D050197:Atherosclerosis / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D001696:Biomechanical Phenomena / Q000502:physiology; D049109:Cell Proliferation / Q000502:physiology; D016922:Cellular Senescence / Q000502:physiology; D018450:Disease Progression; D042783:Endothelial Cells / Q000502:physiology; D004730:Endothelium, Vascular / Q000502:physiology; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D008465:Mechanoreceptors / Q000502:physiology; D058226:Plaque, Atherosclerotic / Q000503:physiopathology; D012422:Rupture, Spontaneous / Q000503:physiopathology; D015398:Signal Transduction / Q000502:physiology; D013314:Stress, Mechanical; D066253:Vascular Remodeling / Q000502:physiology
chemical_list: D015415:Biomarkers
keywords: Atherosclerosis; Blood flow; Endothelial cell; Haemodynamics; Mechanotransduction; Plaque rupture