Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors (JIMG January 2025)-Article: Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors

Article: Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors

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The study investigates coronary microvascular function in middle-aged asymptomatic individuals with cardiometabolic risk factors. Researchers assessed the impacts of cardiovascular risk factors and subclinical atherosclerosis on coronary microvascular function in 453 participants, with results showing that cardiometabolic risk factors and systemic atherosclerosis adversely affect coronary microvascular function. Key metrics included myocardial blood flow (MBF) and myocardial perfusion reserve (MPR), measured through cardiac magnetic resonance imaging (CMR) both at rest and under stress.<br /><br />Median participant age was 52.6 years, with 84.5% male representation. Findings indicated that the presence of cardiovascular risk factors, especially diabetes and metabolic syndrome components, was directly associated with elevated rest MBF but inversely related to MPR. Stress MBF decreased in the presence of coronary artery calcium and subclinical atherosclerosis, with a greater systemic plaque burden further reducing MBF. Importantly, better coronary microvascular function was associated with reduced progression of atherosclerosis over three years.<br /><br />The study confirms earlier findings that cardiovascular risk factors, without symptoms of heart disease, alter coronary microvascular function. This dysfunction could precede or occur simultaneously with atherosclerosis development. Systemic subclinical atherosclerosis was also associated with changes in coronary microvascular function, indicating a link between microvascular dysfunction and macrovascular circulatory compartments. A better understanding of these relationships may provide predictive information regarding future adverse cardiovascular events in asymptomatic individuals.<br /><br />Overall, the study highlights the importance of considering coronary microvascular health in conjunction with overall cardiovascular risk profile and systemic atherosclerotic burden, emphasizing the potential of early intervention strategies in managing cardiometabolic health.

Keywords

coronary microvascular function

cardiometabolic risk factors

subclinical atherosclerosis

myocardial blood flow

myocardial perfusion reserve

cardiac magnetic resonance imaging

cardiovascular risk factors

systemic atherosclerosis

microvascular dysfunction

asymptomatic individuals