A little known condition affecting small blood vessels in the heart could be widespread and an important cause of serious cardiovascular incidents, researchers warn today.
Microvascular angina is intense chest pain caused by problems in the small blood vessels in the heart muscle, with no apparent narrowing in the large coronary arteries on coronary x-rays.
Researchers led by Professor Hiroaki Shimokawa, of Tohoku University, Japan, explain in the European Heart Journal today (27 May) that angina pectoris has been considered to be mainly caused by atherosclerotic coronary artery disease. But in fact, nearly half of sufferers of this pain have normal coronary arteries.
In such cases, coronary microvascular dysfunction may be the cause of reduced blood flow and the resulting pain.
"The term microvascular angina is used for angina/myocardial ischaemia attributable to coronary microvascular dysfunction," the authors write.
In their report they analysed details from 686 patients in seven countries to provide multi-national, multi-ethnic information on the condition, as well as diagnostic criteria.
They write: "This first international study provides novel evidence that microvascular angina is an important health problem regardless of sex or ethnicity that a diagnosis of microvascular angina portends a substantial risk for major cardiovascular events associated with hypertension and previous history of coronary artery disease, and that women have a lower quality of life than men despite the comparable prognosis."
Professor Shimokawa comments: “Microvascular angina is an under-researched area, partly because cardiologists are mainly interested in the large coronary arteries but not the smaller vessels that are also part of the coronary circulation. As a result, many patients are misdiagnosed.
"The number of patients with microvascular angina is three to four million in the USA, which is equal to or greater than the number of patients with breast cancer, so it is an important global problem.”
Shimokawa, H. et al. Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group. European Heart Journal 27 May 2021; doi: 10.1093/eurheartj/ehab282
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