Abstract
AimsCoronary microvascular dysfunction (CMD) carries a poor cardiovascular prognosis and may explain angina in women without obstructive coronary artery disease (CAD). Currently, no evidence-based treatment for CMD exists. We investigated whether reducing cardiovascular risk factors improves symptoms and microvascular function in women with non-endothelial dependent CMD and no obstructive CAD.MethodsWe randomized 62 women aged 40–75, with body mass index (BMI) >25 kg/m2, angina ≥monthly, and coronary flow velocity reserve (CFVR) ≤2.5 to a 24-week intervention comprising low energy diet, exercise training, and optimized treatment of hypertension, dyslipidemia and diabetes or to control. Patients were assessed before randomization and after 24 weeks. Primary outcomes were CFVR assessed by transthoracic Doppler stress-echocardiography and angina burden by Seattle Angina Questionnaire (SAQ). Secondary outcomes were exercise capacity, body composition, glycemic control, myocardial function, and anxiety and depression symptoms.ResultsFifty-six participants (90%) completed the study. Median (IQR) age was 65.2 (57.1;70.7) years, BMI was 30.1 (28.4;32.7) kg/m2. The intervention resulted in relevant improvement in angina symptoms (9-21-point increase on SAQ-scales (all p<0.01)) but had no effect on CFVR (p = 0.468). Mean (CI) weight loss was 9.6 (7.80;11.48) kg, (p<0.0001). There was a significant mean (CI) decrease in depression symptoms = 1.16 (0.22;2.12), triglycerides = 0.52 (0.25;0.78) mmol/L, total cholesterol = 0.55 (0.12;0.98) mmol/L, and HbA1c in diabetics = 27.1 (1.60;52.6) mmol/mol but no effect on other secondary outcomes.ConclusionA major weight loss and intensified risk factor control resulted in significantly improved angina burden but no improvement of coronary microvascular function among women with microvascular angina.
Highlights
A major weight loss and intensified risk factor control resulted in significantly improved angina burden but no improvement of coronary microvascular function among women with microvascular angina
Most women with suspected angina pectoris have no obstructive coronary artery disease (CAD) [1] yet many continue to have symptoms resulting in frequent hospital re-admissions, anxiety and depression, impaired quality of life, and an adverse prognosis [2]
No randomized controlled trial has examined whether a comprehensive intervention targeting coronary microvascular dysfunction (CMD) risk factors improves microvascular angina (MVA)
Summary
Most women with suspected angina pectoris have no obstructive coronary artery disease (CAD) [1] yet many continue to have symptoms resulting in frequent hospital re-admissions, anxiety and depression, impaired quality of life, and an adverse prognosis [2]. A few intervention studies have indicated improved coronary microvascular function after treatment of modifiable risk factors including exercise training, weight loss [8, 9] and optimized medical treatment [10, 11]. No randomized controlled trial has examined whether a comprehensive intervention targeting CMD risk factors improves MVA. We hypothesized that amelioration of risk factors for CMD would improve both angina and coronary microvascular function. We tested this hypothesis by randomizing symptomatic women with CMD and no obstructive epicardial disease to an intervention comprising weight loss, aerobic interval training (AIT), and optimal medical treatment of hypertension, dyslipidemia and diabetes versus usual care
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