The Risk Continuum of Atherosclerosis and its Implications for Defining CHD by Coronary Angiography

Area of Science:

• Cardiology
• Preventive Medicine
• Diagnostic Imaging

Background:

• Coronary heart disease (CHD) diagnosis often relies on obstructive coronary atherosclerosis (>50% stenosis).
• Symptomatic patients with nonobstructive coronary atherosclerosis (<50% stenosis) lack clear management guidelines.
• Current diagnostic criteria for CHD are not met in patients with nonobstructive disease, delaying secondary preventive measures.

Purpose of the Study:

• To highlight the risk of adverse cardiac events in patients with nonobstructive coronary atherosclerosis.
• To emphasize the missed opportunity for secondary preventive measures in this patient population.
• To advocate for a risk-continuous approach in diagnosing and managing coronary atherosclerosis.

Main Methods:

• Review of available data on patients undergoing coronary angiography for suspected CHD.
• Analysis of clinical outcomes in patients with nonobstructive coronary atherosclerosis compared to those with obstructive disease.
• Evaluation of current clinical practice guidelines regarding nonobstructive coronary atherosclerosis management.

Main Results:

• Patients with coronary atherosclerotic disease and <50% diameter stenosis may have similar risks of adverse cardiac events as those with single-vessel obstructive disease.
• Millions of patients with nonobstructive coronary heart disease are potentially missing effective preventive measures.
• Current guidelines do not provide direction for managing symptomatic patients with nonobstructive coronary atherosclerosis.

Conclusions:

• There is a need to recognize the risk continuum of coronary atherosclerosis beyond obstructive disease.
• Secondary preventive measures should be considered for symptomatic patients with nonobstructive coronary atherosclerosis.
• Noninvasive coronary angiography offers an opportunity to re-evaluate CHD diagnosis and management strategies.