Environmental factors that influence the response of the endothelium to flow
Complications from cardiovascular disease, such as heart attack and stroke, represent the leading cause of death in the United States and many developed and developing countries. In 2008, approximately 672,000 people died of heart disease or stroke, which accounts for about 27% of all deaths (Roger et al. 2012). While mortality and morbidity is decreasing in the United States (Roger et al. 2012), the incidence of the disease is increasing in developed countries such as China and India. Atherosclerosis is the primary pathology underlying heart disease and stroke. The disease is localized to large and medium sized arteries and involves a complex sequence of events in which the accumulation of lipids and cholesterol in the arterial intima initiates an inflammatory response. The result is a thickened intima consisting of lipids, macrophages and smooth muscle cells. The thickened intima can compromise blood flow or rupture, causing a thrombus to form, blocking blood flow and precipitating a heart attack or stroke. The earliest events in the disease process involve changes to the function of endothelium leading to increased adhesion of leukocytes, altered permeability and decreased release of the vasodilator nitric oxide (NO). Risk factors for atherosclerosis include age, high cholesterol levels, diabetes, genetics, hypertension, and smoking (Chu and Peters 2008).
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