Coronary microvascular disease in women: epidemiology, mechanisms, evaluation, and treatment

Area of Science:

• Cardiology
• Vascular Biology
• Internal Medicine

Background:

• Coronary microvascular dysfunction (CMD) involves abnormalities in small coronary vessels, leading to reduced coronary blood flow (CBF) and myocardial ischemia.
• This ischemia manifests as microvascular angina (MVA), often occurring without obstructive epicardial coronary artery disease (CAD).
• CMD and MVA are more common in women and associated with higher cardiovascular event risk.

Purpose of the Study:

• To review recent discoveries in CMD mechanisms.
• To explore novel therapeutic strategies for CMD management.
• To highlight sex-specific differences in CMD presentation and pathophysiology.

Main Methods:

• Non-invasive imaging techniques for CMD diagnosis.
• Invasive coronary function testing (CFT) to assess endothelial and microcirculation function.
• Review of current literature on CMD pathophysiology and treatment.

Main Results:

• CMD diagnosis can be challenging due to its frequent dissociation from obstructive epicardial CAD.
• MVA prevalence and associated risks are notably higher in women.
• Treatment requires a personalized approach targeting specific patient risk factors and endotypes.

Conclusions:

• CMD is a significant cause of myocardial ischemia and angina, particularly in women.
• Further research into novel mechanisms and sex-specific treatments is crucial.
• Personalized, endotype-targeted therapies offer the most promise for managing symptomatic CMD.