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Background Cardiovascular disease and cancer share common pathogenesis and risk factors. Coronary microvascular dysfunction (CMD), reflecting impaired coronary microvascular dilation in response to stress, is related to a higher risk of major cardiovascular events; however, its association with cancer has not been explored. Methods A retrospective study on 1042 patients with non-obstructive coronary artery diseases was performed. Data regarding demographic, clinical history, diagnostic coronary reactivity test, and cancer occurrence was collected. CMD was defined as coronary flow reserve (CFR, the ratio of hyperemic blood flow to resting blood flow) ≤2.5. Results Thirty-four percent had CMD (67.4% female and the average age was 52.4 ± 12.2 years). Of 917 patients with no history of cancer, 15.5% developed cancer during follow-up (median of 9 (4,16) years). Kaplan-Meier analysis showed CMD patients had lower cancer-free survival compared to those without CMD (log-rank p = 0.005). Cox proportional hazard analyses showed that after adjusting for age, sex, hypertension, diabetes, smoking, and glomerular filtration rate, CMD is independently associated with cancer (HR, 1.4, 95%CI, 1.09-2.04, p = 0.04). The rate of MACE was significantly higher in CMD compared to those non-CMD patients in patients who had a previous history of cancer (OR, 2.5, 95%CI, 1-6.2, p = 0.04) and patients with no history of cancer (OR, 1.4, 95%CI, 1.01-1.9, p = 0.044). Conclusion CMD is associated with cancer incidence in patients presenting with non-obstructive coronary artery diseases. This study emphasizes the following-up in patients with CMD to evaluate the risk of MACE as well as potential malignant diseases.
Background Cardiovascular disease and cancer share common pathogenesis and risk factors. Coronary microvascular dysfunction (CMD), reflecting impaired coronary microvascular dilation in response to stress, is related to a higher risk of major cardiovascular events; however, its association with cancer has not been explored. Methods A retrospective study on 1042 patients with non-obstructive coronary artery diseases was performed. Data regarding demographic, clinical history, diagnostic coronary reactivity test, and cancer occurrence was collected. CMD was defined as coronary flow reserve (CFR, the ratio of hyperemic blood flow to resting blood flow) ≤2.5. Results Thirty-four percent had CMD (67.4% female and the average age was 52.4 ± 12.2 years). Of 917 patients with no history of cancer, 15.5% developed cancer during follow-up (median of 9 (4,16) years). Kaplan-Meier analysis showed CMD patients had lower cancer-free survival compared to those without CMD (log-rank p = 0.005). Cox proportional hazard analyses showed that after adjusting for age, sex, hypertension, diabetes, smoking, and glomerular filtration rate, CMD is independently associated with cancer (HR, 1.4, 95%CI, 1.09-2.04, p = 0.04). The rate of MACE was significantly higher in CMD compared to those non-CMD patients in patients who had a previous history of cancer (OR, 2.5, 95%CI, 1-6.2, p = 0.04) and patients with no history of cancer (OR, 1.4, 95%CI, 1.01-1.9, p = 0.044). Conclusion CMD is associated with cancer incidence in patients presenting with non-obstructive coronary artery diseases. This study emphasizes the following-up in patients with CMD to evaluate the risk of MACE as well as potential malignant diseases.
Research involving human subjects in ambulatory settings is a critical link in the chain comprising translational research, spanning preclinical research to human subject and patient cohort studies. There are presently a wide array of techniques and approaches available to investigators wishing to study blood flow, perfusion, and vascular structure and function in human subjects. In this multi-sectioned review, we discuss capillaroscopy, carotid intima-media thickness, flow-mediated dilation, laser Doppler flowmetry, near-infrared spectroscopy, peripheral arterial tonometry, pulse wave velocity, retinal fundus imaging, and vascular plethysmography. Each section contains a general overview and the physical basis of the technique followed by a discussion of the procedures involved and the necessary equipment, with attention paid to specific requirements or limitations. Subsequently, we detail which aspects of vascular function can be studied with a given technique, the analytical approach to the collected data, and the appropriate application and limitation(s) to the interpretation of the data collected. Finally, a modified scoping review provides a summary of how each assessment technique has been applied in previous studies. It is anticipated that this review will provide an efficient source of information and insight for preclinical investigators seeking to add translational aspects to their research programs.
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