Conway Review Lecture 2001
10/09/2001 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2
Atheroma and the mechanics of blood flow in arteries
H. Mike Snow, Department of Physiology, University College Cork, Ireland
It has long been recognised that the distribution of atheroma and atherosclerosis throughout the arterial system of man is markedly uneven. In an extensive study, Mitchell and Schwartz’ reported that atheroma was found most frequently in the large conduit arteries, the aorta and its major first order branches. Smaller, higher order branches were rarely affected and arterioles not at all. Even within the large arteries the distribution is uneven, preferred sites being the inner wall of bends, the outer walls of flow dividers and the posterior wall of the aorta. The 19th century pathologists, Rokitansky and Virchow, proposed a triad of causes for atheroma and atherosclerosis, blood composition, pathology of the intima and mechanical forces resulting from blood flow. Of these causes, variations in the mechanical forces throughout the arterial tree have been thought to provide a possible explanation for the uneven distribution of atheroma which, when coupled with pathology of the intima, leads eventually to the development of atherosclerosis. The problem has been to find a satisfactory explanation linking mechanical forces to atheroma and atherosclerosis. The solution to the problem draws on ideas and evidence across scientific disciplines from mathematics to biology an aspect of which Conway would have approved.