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The risk of acute coronary events in microvascular disease
Giuseppe Varrichione1, Flavio Giuseppe Biccirè1, Riccardo Di Pietro2
1CLI Foundation.
Insights
Microvascular disease, common in women, causes angina and heart issues. Recent studies link it to worse outcomes, including heart attack and cardiac death, challenging previous beliefs about its benign prognosis.
Area of Science:
- Cardiology
- Vascular Biology
- Public Health
Background:
- Microvascular disease is a prevalent condition, particularly affecting women.
- It can cause myocardial ischemia and angina, with or without significant epicardial coronary artery disease.
- Cardiovascular risk factors for microvascular disease mirror those of epicardial atherosclerotic disease.
Purpose of the Study:
- To clarify the prognostic significance of microvascular dysfunction.
- To investigate the association between microvascular disease and the risk of myocardial infarction and sudden death.
- To explore the link between microvascular disease and the progression of coronary epicardial atherosclerosis.
Main Methods:
- Review of recent studies investigating microvascular disease.
- Analysis of cardiovascular risk factors in patients with microvascular disease.
- Assessment of cardiovascular event rates in subjects with and without significant coronary stenoses.
Main Results:
- Evidence suggests an association between microvascular disease and the progression of coronary epicardial atherosclerosis.
- Subjects with microvascular dysfunction and coronary arteries without significant stenoses may face an increased risk of adverse cardiovascular events.
- Recent studies indicate a potential link between microvascular disease and increased risk of myocardial infarction and sudden death.
Conclusions:
- The prognosis of microvascular disease is likely not benign.
- Microvascular disease is associated with an increased risk of cardiovascular events, including revascularization, myocardial infarction, and cardiac death.
- Further research is warranted to fully elucidate the long-term implications of microvascular dysfunction.
Abstract:
The microvascular disease represents a widespread clinical entity in the general population, especially among women. The dysfunction of the microcirculation is often responsible for myocardial ischaemia and angina in the absence of significant stenosis of the epicardial district, while in other cases it can represent a contributing cause of angina even in the presence of coronary artery disease, cardiomyopathies or heart failure. The cardiovascular risk factors of people with microvascular disease are similar to those who develop epicardial atherosclerotic disease. However, the prognostic significance of microvascular disease remains a matter of debate. An element to be clarified, in fact, is whether subjects with dysfunction of the microcirculation and coronary tree without significant stenoses present an increased risk of myocardial infarction and sudden death. In recent years, several studies seem to confirm an association between microvascular disease and progression of coronary epicardial atherosclerosis. The prognosis of microvascular disease would therefore not be benign as was previously believed, but associated with an increased risk of cardiovascular events including revascularization, heart attack, and cardiac death.
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