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Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy

Jenna Dean1, Sherwin Dela Cruz1, Puja K Mehta1

  • 1Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3600, Los Angeles, CA 90048, USA.

Nature Reviews. Cardiology
|May 27, 2015
PubMed

Insights

Coronary microvascular dysfunction is a key cause of myocardial ischaemia, especially in women who often lack obstructive coronary artery disease. Further research is needed to guide effective treatments for this condition.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Women's Health

Background:

  • Cardiovascular disease remains the leading global cause of mortality.
  • Women with myocardial ischaemia symptoms frequently lack obstructive coronary artery disease (CAD), leading to misdiagnosis.
  • Coronary microvascular dysfunction (CMD) is increasingly recognized as a cause of ischaemic heart disease.

Purpose of the Study:

  • To review the prevalence, presentation, diagnosis, and treatment of coronary microvascular dysfunction.
  • To highlight the specific challenges and considerations for ischaemic heart disease in women.
  • To emphasize the importance of considering CMD in patients without obstructive CAD.

Main Methods:

  • This is a review article, synthesizing existing literature.
  • The review discusses diagnostic criteria and therapeutic approaches for CMD.
  • Emphasis is placed on clinical presentation and epidemiological data.

Main Results:

  • Coronary microvascular dysfunction is characterized by impaired coronary flow reserve due to microcirculatory abnormalities.
  • It is associated with adverse cardiovascular outcomes and is often overlooked in women.
  • Current treatments may include lifestyle changes and medications, but outcome data are limited.

Conclusions:

  • Coronary microvascular dysfunction is a significant contributor to ischaemic heart disease, particularly in women.
  • Accurate diagnosis and targeted therapies for CMD are crucial for improving cardiovascular prognosis.
  • Further clinical trials are essential to establish evidence-based treatment guidelines for CMD.

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