Microvascular inflammation in atherosclerosis

Vitiello, Laura; Spoletini, Ilaria; Gorini, Stefania; Pontecorvo, Laura; Ferrari, Davide; Ferraro, Elisabetta; Stabile, Eugenio; Caprio, Massimiliano; Sala, A.

doi:10.1016/j.ijcme.2014.03.002

Cited by 27 publications

(17 citation statements)

References 97 publications

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“…62 Evidence linking microvascular and inflammatory responses to risk factors indicates that oxidative stress, reduced nitric-oxide (NO)-bioavailability, and endothelial activation are common early features of coronary microvascular responses to atherosclerosis risk factors. 63 …”

Section: Pathophysiologymentioning

confidence: 99%

Ischemia and No Obstructive Coronary Artery Disease (INOCA)

Merz¹,

Pepine²,

Walsh³

et al. 2017

Circulation

575

249

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The Cardiovascular Disease in Women Committee of the American College of Cardiology, in conjunction with interested parties (from the National Heart, Lung, and Blood Institute, American Heart Association, European Society of Cardiology), convened a working group to develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries (INOCA). In general, these patients have elevated risk for a cardiovascular event (including acute coronary syndrome, heart failure hospitalization, stroke, and repeated cardiovascular procedures) vs reference subjects, and appear to be at higher risk for development of heart failure with preserved ejection fraction (HFpEF). A subgroup of these patients also has coronary microvascular dysfunction (CMD) and evidence of inflammation. This document provides a summary of findings and recommendations toward the development of an integrated approach for identifying and managing patients with INOCA, and outlining knowledge gaps in the area. Working group members critically reviewed available literature and current practices for risk assessment and state-of-the-science techniques in multiple areas, with a focus on next steps needed to develop evidence-based therapies. This report presents highlights of this working group review and a summary of suggested research directions to advance this field in the next decade.

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Section: Pathophysiologymentioning

confidence: 99%

Ischemia and No Obstructive Coronary Artery Disease (INOCA)

Merz¹,

Pepine²,

Walsh³

et al. 2017

Circulation

575

249

View full text Add to dashboard Cite

show abstract

“…The pathophysiology of atherosclerosis is now clearly related to chronic inflammation with periods of minor plaque rupture, erosion, and distal embolism resulting in MI . Evidence linking microvascular and inflammatory responses to risk factors indicates that oxidative stress, reduced nitric oxide (NO) bioavailability, and endothelial activation are common early features of coronary microvascular responses to atherosclerosis risk factors . Essentially, all INOCA patients with chronic angina studied by intravascular ultrasound (IVUS) to date have some coronary atherosclerosis .…”

Section: Pathophysiologymentioning

confidence: 99%

“…25 Evidence linking microvascular and inflammatory responses to risk factors indicates that oxidative stress, reduced nitric oxide (NO) bioavailability, and endothelial activation are common early features of coronary microvascular responses to atherosclerosis risk factors. 26 Essentially, all INOCA patients with chronic angina studied by intravascular ultrasound (IVUS) to date have some coronary atherosclerosis. 27,28 A greater burden of risk factors is associated with more atherosclerosis, concealed by compensatory positive remodeling, yielding diffuse nonobstructive CAD.…”

Section: Atherosclerosismentioning

confidence: 99%

Why names matter for women: MINOCA/INOCA (myocardial infarction/ischemia and no obstructive coronary artery disease)

Pacheco

Quesada

Pepine

et al. 2018

Clinical Cardiology

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The syndromes of myocardial infarction/myocardial ischemia with No Obstructive Coronary Artery Disease (MINOCA/INOCA) are increasingly evident. A majority of these patients have coronary microvascular dysfunction. These patients have elevated risk for a cardiovascular event (including acute coronary syndrome, myocardial infarction, stroke, and repeated cardiovascular procedures) and appear to be at higher risk for development of heart failure with preserved ejection fraction. Terminology such as coronary artery disease or coronary heart disease is often synonymous with obstructive atherosclerosis in the clinician's mind, leaving one at a loss to recognize or explain the phenomenon of MINOCA and INOCA with elevated risk. We review the available literature regarding stable and unstable ischemic heart disease that suggests that use of the ischemic heart disease (IHD) terminology matters for women, and should facilitate recognition of risk to provide potential treatment targets and optimized health.

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“…[4][5][6] In various animal and human model of atherosclerosis, circulating blood components like neutrophil, lymphocyte, platelets, and other inflammatory mediators were found in the lesions. 7 Pathophysiology of atherosclerosis involves chemotactic proteins and adhesion molecules mediated recruitment of circulating leucocytes and platelets to the injured endothelium site. 8 Damage to the endothelium upsets the balance between vasoconstriction and vasodilation that promotes the endothelial permeability, platelet aggregation, leukocyte adhesion, and generation of cytokines ultimately initiating deleterious events of atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%