Nonobstructive Coronary Artery Disease – Clinical Relevance, Diagnosis, Management and Proposal of New Pathophysiological Classification

Abstract

SUMMARY – New data gathered from large clinical trials indicate that nonobstructive coronary artery disease (non-CAD) is a clinical entity that should not be ignored. It is estimated that 50% of female population undergoing coronarography are diagnosed with non-CAD. There is also an increase in the prevalence of non-CAD in both genders, which is probably due to gradual expanding of clinical indications for angiography in patients with angina. Furthermore, considering the increased mortality risk established recently, a prognosis of non-CAD is not benign as previously thought. However, the concept and definition of non-CAD remains elusive causing difficulties in diagnosis and treatment. One of the major shortcomings is the exclusion-based diagnosis of non-CAD. Furthermore, treatment of non-CAD still presents a great challenge and optimal therapy is yet to be determined. There are two major hypotheses explaining the pathophysiological mechanisms of non-CAD, i.e. ischemic hypothesis based on abnormal microvascular dysfunction and non-ischemic one based on altered pain perception. This review encompasses a broader spectrum of pathophysiological mechanisms of non-CAD, and proposes a new way of classification based on the major disorder involved: type I (ischemic mechanisms) and type II (non-ischemic mechanisms), depending on which mechanism predominates. Hopefully, this would provide new insights in the understanding of this disorder, thus leading to accurate and early diagnosis and successful treatment, especially considering the increased mortality risk in these patients.

Safety and Effects of Crataegus Extract WS 1442 and Nordic Walking on Lipid Profile and Endothelial Function: a Randomized, Partially Blinded Pilot Study in Overweight Volunteers

“…Nevertheless, compliance has also been identified as a relevant issue in preventive pharmacotherapy, as demonstrated in the EU-ROASPIRE trials 40 . Current guidelines and recommendations suggest physical exercise training and dietary measures in otherwise healthy individuals who are overweight but not obese, whereas pharmacological treatment is only recommended if comorbidities are already present 2,41 . Individuals at risk of CVD may nevertheless prefer a drug over lifestyle modification, or they may not be able to exercise due to physical disability.…”

Impact of increased serum 8-hydroxy-2′-deoxyguanosine levels on extent of coronary artery lesions in elderly patients with type 2 diabetes

“…5 , 6 Patients with obstructive coronary disease defined as ≥50% stenosis of coronary vessels on coronarography were included. 7 The extent of the lesion in CHD was evaluated as described previously. 8 The final score for each patient was the sum of all the affected branches.…”

The Relationship Between the Incidence of Coronary Heart Disease and Ethnic Minorities

“…According to the type of hospitalization, the subjects were divided into planned and emergency patients. To assess the state of the coronary vessels, during coronary angiography, the lesion of at least one epicardial coronary artery with stenosis of ≥50% was considered hemodynamically significant, which was determined by computer-digital analysis (34).…”