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Updated: Jun 26, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors
Ana Devesa1, Valentin Fuster2, Inés García-Lunar3
1Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Cardiometabolic risk factors and subclinical atherosclerosis impair coronary microvascular function in healthy middle-aged adults. Better microvascular function is linked to reduced atherosclerosis progression over time.
Area of Science:
- Cardiology
- Vascular Biology
- Preventive Medicine
Background:
- Coronary microvascular dysfunction is linked to poor outcomes in ischemic heart disease.
- Data on microvascular function in healthy individuals is limited.
- Understanding microvascular function in asymptomatic individuals is crucial for early risk assessment.
Purpose of the Study:
- To evaluate the impact of cardiovascular risk factors on coronary microvascular function.
- To assess the relationship between subclinical atherosclerosis and microvascular function.
- To investigate these associations in middle-aged, asymptomatic individuals.
Main Methods:
- Cardiac magnetic resonance imaging (MRI) assessed myocardial blood flow (MBF) and myocardial perfusion reserve (MPR).
- Subclinical atherosclerosis was evaluated using vascular ultrasound and coronary artery calcium scoring.
- Data were collected at baseline and a 3-year follow-up.
Main Results:
- Resting MBF correlated with metabolic syndrome components, insulin resistance, and diabetes.
- MPR was reduced in individuals with metabolic syndrome and insulin resistance.
- Stress MBF was inversely associated with coronary artery calcium and plaque burden.
- Higher MBF and MPR predicted less atherosclerosis progression over 3 years.
Conclusions:
- Cardiometabolic risk factors and systemic subclinical atherosclerosis are associated with impaired coronary microvascular function in asymptomatic individuals.
- Good coronary microvascular function is linked to reduced atherosclerosis progression.
- These findings highlight the importance of microvascular health in early cardiovascular disease prevention.
Background:
In patients with ischemic heart disease, coronary microvascular dysfunction is associated with cardiovascular risk factors and poor prognosis; however, data from healthy individuals are scarce.
Objectives:
The purpose of this study was to assess the impact of cardiovascular risk factors and subclinical atherosclerosis on coronary microvascular function in middle-aged asymptomatic individuals.
Methods:
Myocardial perfusion was measured at rest and under stress using cardiac magnetic resonance in 453 individuals and used to generate myocardial blood flow (MBF) maps and calculate myocardial perfusion reserve (MPR). Subclinical atherosclerosis was assessed using 3-dimensional vascular ultrasound of the carotid and femoral arteries and coronary artery calcium scoring at baseline and at 3-year follow-up.
Results:
Median participant age was 52.6 years (range: 48.9-55.8 years), and 84.5% were male. After adjusting for age and sex, rest MBF was directly associated with the number of the metabolic syndrome components present (elevated waist circumference, systolic and diastolic blood pressure, fasting glucose, and triglycerides and low high-density lipoprotein cholesterol), insulin resistance (homeostatic model assessment for insulin resistance), and presence of diabetes. MPR was reduced in the presence of several metabolic syndrome components, elevated homeostatic model assessment for insulin resistance, and diabetes. Stress MBF was inversely associated with coronary artery calcium presence and with global plaque burden. Higher stress MBF and MPR were associated with less atherosclerosis progression (increase in plaque volume) at 3 years.
Conclusions:
In asymptomatic middle-aged individuals free of known cardiovascular disease, the presence of cardiometabolic risk factors and systemic (poly-vascular) subclinical atherosclerosis are associated with impaired coronary microvascular function. Better coronary microvascular function reduces atherosclerosis progression at follow-up. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).
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