Abstract
Elevated blood viscosity is an integral component of vascular shear stress that contributes to the site specificity of atherogenesis, rapid growth of atherosclerotic lesions, and increases their propensity to rupture. Ex vivo measurements of whole blood viscosity (WBV) is a predictor of cardiovascular events in apparently healthy individuals and studies of cardiovascular disease patients. The association of an elevated WBV and incident cardiovascular events remains significant in multivariate models that adjust for major cardiovascular risk factors. These prospective data suggest that measurement of WBV may be valuable as part of routine cardiovascular profiling, thereby potentially useful data for risk stratification and therapeutic interventions. The recent development of a high throughput blood viscometer, which is capable of rapidly performing blood viscosity measurements across 10,000 shear rates using a single blood sample, enables the assessment of blood flow characteristics in different regions of the circulatory system and opens new opportunities for detecting and monitoring cardiovascular diseases.
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References
Baskurt OK, Meiselman HJ. Blood rheology and hemodynamics. Semin Thromb Hemost. 2003;29:435–50.
Frangos SG, Gahtan V, Sumpio B. Localization of atherosclerosis: role of hemodynamics. Arch Surg. 1999;134:1142–9.
Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA. 1999;282:2035–42.
Lee AJ, Mowbray PI, Lowe GD, Rumley A, Fowkes FG, Allan PL. Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. Circulation. 1998;97:1467–73.
Kensey KR. The mechanistic relationships between hemorheological characteristics and cardiovascular disease. Curr Med Res Opin. 2003;19:587–96.
Rosencranz R, Bogen SA. Clinical laboratory measurement of serum, plasma, and blood viscosity. Am J Clin Pathol. 2006;125:S78–86.
Cokelet GR, Goldsmith HL. Decreased hydrodynamic resistance in the two-phase flow of blood through small vertical tubes at low flow rates. Circ Res. 1991;68:1–17.
Stuart J, Kenny MW. Blood rheology. J Clin Pathol. 1980;33:417–29.
Fung YC. Biomechanics: mechanical properties of living tissues. 1st ed. New York: Springer; 1981. p. 101–37.
Gaehtgens P, Pries AR, Ley K. Structural, hemodynamic and rheological characteristics of blood flow in the circulation. In: Chien S, Dormandy J, Ernst E, Matrai A, editors. Clinical hemorheology: applications in cardiovascular and haematological disease, diabetes, surgery, and gynecology. 1st ed. Boston: Martinus Nijhoff; 1987. p. 97–124.
Meiselman HJ. Rheology of shape-transformed human red cells. Biorheology. 1978;15:225–37.
Goldsmith HL, Cokelet GR, Gaehtgens P. Robin Fåhraeus: evolution of his concepts in cardiovascular physiology. Am J Physiol. 1989;257:H1005–15.
Wan J, Forsyth AM, Stone HA. Red blood cell dynamics: from cell deformation to ATP release. Integr Biol. 2011;3:972–81.
Dintenfass L. Blood microrheology: viscosity factors in blood flow, ischaemia, and thrombosis. An introduction to molecular and clinical haematology. 1st ed. New York: Appleton-Century-Crofts; 1971.
Dinnar U. Cardiovascular fluid mechanics. 1st ed. Boca Raton: CRC Press; 1981.
Seplowitz AH, Chien S, Smith FR. Effects of lipoproteins on plasma viscosity. Atherosclerosis. 1981;38:89–95.
Leonhardt H, Arntz HR, Klemens UH. Studies of plasma viscosity in primary hyperlipoproteinaemia. Atherosclerosis. 1977;28:29–40.
Ditzel J, Kampmann J. Whole-blood viscosity, hematocrit and plasma protein in normal subjects at different ages. Acta Physiol Scand. 1971;81:264–8.
Harkness J. The viscosity of human blood plasma; its measurement in health and disease. Biorheology. 1971;8:171–93.
Charm SE, Paz H, Kurland GS. Reduced plasma viscosity among joggers compared with non-joggers. Biorheology. 1979;16:185–9.
Dintenfass L. Rheology of blood in diagnostic and preventive medicine. 1st ed. London: Butterworth; 1976.
Dormandy JA. Medical and engineering problems of blood viscosity. Biomed Eng. 1974;9:284–9.
Lowe GD. Blood rheology in arterial disease. Clin Sci (Lond). 1986;71:137–46.
Rosenson RS, Lowe GD. Effects of lipids and lipoproteins on thrombosis and rheology. Atherosclerosis. 1998;140:271–80.
Sloop GD, Garber DW. The effects of low-density lipoprotein and high-density lipoprotein on blood viscosity correlate with their association with risk of atherosclerosis in humans. Clin Sci (Lond). 1997;92:473–9.
Lowe GD. Blood viscosity, lipoproteins, and cardiovascular risk. Circulation. 1992;85:2329–31.
Høieggen A, Fossum E, Moan A, Enger E, Kjeldsen SE. Whole-blood viscosity and the insulin-resistance syndrome. J Hypertens. 1998;16:203–10.
Sloop GD. A unifying theory of atherogenesis. Med Hypotheses. 1996;47:321–5.
Fowkes FG, Lowe GD, Rumley A, Lennie SE, Smith FB, Donnan PT. The relationship between blood viscosity and blood pressure in a random sample of the population aged 55 to 74 years. Eur Heart J. 1993;14:597–601.
Smith WC, Lowe GD, Lee AJ, Tunstall-Pedoe H. Rheological determinants of blood pressure in a Scottish adult population. J Hypertens. 1992;10:467–72.
Letcher RL, Chien S, Pickering TG, Sealey JE, Laragh JH. Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. Role of fibrinogen and concentration. Am J Med. 1981;70:1195–202.
Devereux RB, Case DB, Alderman MH, Pickering TG, Chien S, Laragh JH. Possible role of increased blood viscosity in the hemodynamics of systemic hypertension. Am J Cardiol. 2000;85:1265–8.
Zannad F, Stoltz JF. Blood rheology in arterial hypertension. J Hypertens Suppl. 1992;10:S69–78.
Zannad F, Voisin P, Brunotte F, Bruntz JF, Stoltz JF, Gilgenkrantz JM. Haemorheological abnormalities in arterial hypertension and their relation to cardiac hypertrophy. J Hypertens. 1988;6:293–7.
Slonim A, Cristal N. Cardiovascular diseases, blood rheology, and dihydropyridine calcium antagonists. J Cardiovasc Pharmacol. 1992;19:S96–8.
Kearney-Schwartz A, Virion JM, Stoltz JF, Drouin P, Zannad F. Haemorheological disturbances in hypertensive type 2 diabetic patients—influence of antihypertensive therapy. Fundam Clin Pharmacol. 2007;21:387–96.
Kwiterovich Jr PO. The metabolic pathways of high-density lipoprotein, low-density lipoprotein, and triglycerides: a current review. Am J Cardiol. 2000;86:5L–10L.
de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81:107–17.
Rosenson RS, McCormick A, Uretz EF. Distribution of blood viscosity values and biochemical correlates in healthy adults. Clin Chem. 1996;42:1189–95.
Sloop GD, Garber DW. The effects of low-density lipoprotein and high-density lipoprotein on blood viscosity correlate with their association with risk of atherosclerosis in humans. Clin Sci (Lond). 1997;92:473–9.
Koenig W, Sund M, Ernst E, Mraz W, Hombach V, Keil U. Association between rheology and components of lipoproteins in human blood. Results from the MONICA project. Circulation. 1992;85:2197–204.
Stamos TD, Rosenson RS. Low high density lipoprotein levels are associated with an elevated blood viscosity. Atherosclerosis. 1999;146:161–5.
Jaeger BR. Evidence for maximal treatment of atherosclerosis: drastic reduction of cholesterol and fibrinogen restores vascular homeostasis. Ther Apher. 2001;5:207–11.
Carroll S, Cooke CB, Butterly RJ. Plasma viscosity, fibrinogen and the metabolic syndrome: effect of obesity and cardiorespiratory fitness. Blood Coagul Fibrinolysis. 2000;11:71–8.
Jax TW, Peters AJ, Plehn G, Schoebel FC. Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes—a two year follow-up of 243 patients. Cardiovasc Diabetol. 2009;8:48.
Libby P, Ridker PM, Maseri A. Inflammation and Atherosclerosis. Circulation. 2002;105:1135–43.
Cho YI, Mooney MP, Cho DJ. Hemorheological disorders in diabetes mellitus. J Diabetes Sci Technol. 2008;2:1130–8.
Lowe GD, Drummond MM, Forbes CD, Barbenel JC. The effects of age and cigarette-smoking on blood and plasma viscosity in men. Scott Med J. 1980;25:13–7.
Levenson J, Simon AC, Cambien FA, Beretti C. Cigarette smoking and hypertension. Factors independently associated with blood hyperviscosity and arterial rigidity. Arteriosclerosis. 1987;7:572–7.
Ernst E, Koenig W, Matrai A, Filipiak B, Stieber J. Blood rheology in healthy cigarette smokers. Results from the MONICA project, Augsburg. Arteriosclerosis. 1988;8:385–8.
Ernst E. Haemorheological consequences of chronic cigarette smoking. J Cardiovasc Risk. 1995;2:435–9.
Wannamethee SG, Lowe GD, Shaper AG, Rumley A, Lennon L, Whincup PH. The metabolic syndrome and insulin resistance: relationship to haemostatic and inflammatory markers in older non-diabetic men. Atherosclerosis. 2005;181:101–8.
Yarnell JW. Smoking and cardiovascular disease. QJM. 1996;89:493–8.
Fowkes FG, Pell JP, Donnan PT, et al. Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis. Importance of plasma fibrinogen and blood viscosity. Arterioscler Thromb. 1994;14:862–8.
Kameneva MV, Watach MJ, Borovetz HS. Gender difference in rheologic properties of blood and risk of cardiovascular diseases. Clin Hemorheol Microcirc. 1999;21:357–63.
Yarnell JW, Sweetnam PM, Rumley A, Lowe GD. Lifestyle and hemostatic risk factors for ischemic heart disease: the Caerphilly Study. Arterioscler Thromb Vasc Biol. 2000;20:271–9.
Feher G, Koltai K, Kesmarky G, Szapary L, Juricskay I, Toth K. Hemorheological parameters and aging. Clin Hemorheol Microcirc. 2006;35:89–98.
Carallo C, Irace C, De Franceschi MS, et al. The effect of aging on blood and plasma viscosity. An 11.6 years follow-up study. Clin Hemorheol Microcirc. 2011;47:67–74.
Kensey KR, Cho YI. Protective adaptation hypothesis as the etiology of atherosclerosis. J Invasive Cardiol. 1992;4:448–58.
Friedman MH, Bargeron CB, Deters OJ, Hutchins GM, Mark FF. Correlation between wall shear and intimal thickness at a coronary artery branch. Atherosclerosis. 1987;68:27–33.
Texon M. The hemodynamic basis of atherosclerosis. Further observations: the bifurcation lesion. Bull N Y Acad Med. 1976;52:187–200.
Lowe GD, Fowkes FG, Dawes J, Donnan PT, Lennie SE, Housley E. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation. 1993;87:1915–20.
Danesh J, Collins R, Peto R, Lowe GD. Haematocrit, viscosity, erythrocyte sedimentation rate: meta-analyses of prospective studies of coronary heart disease. Eur Heart J. 2000;21:515–20.
Koenig W, Sund M, Filipiak B, Doring A, Lowel H, Ernst E. Plasma viscosity and the risk of coronary heart disease: results from the MONICA-Augsburg Cohort Study, 1984 to 1992. Arterioscler Thromb Vasc Biol. 1998;18:768–72.
Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96:168–73.
Wang S, Boss AH, Kensey KR, Rosenson RS. Variations of whole blood viscosity using Rheolog scanning capillary viscometer. Clin Chim Acta. 2003;332:79–82.
Kim S, Cho YI, Hogenauer WN, Kensey KR. A method of isolating surface tension and yield stress effects in a U-shaped scanning capillary-tube viscometer using a Casson model. J Non-Newtonian Fluid Mech. 2002;103:205–19.
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Cowan, A.Q., Cho, D.J. & Rosenson, R.S. Importance of Blood Rheology in the Pathophysiology of Atherothrombosis. Cardiovasc Drugs Ther 26, 339–348 (2012). https://doi.org/10.1007/s10557-012-6402-4
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DOI: https://doi.org/10.1007/s10557-012-6402-4