Inflammation in Coronary Microvascular Dysfunction

Abstract

Chronic low-grade inflammation is involved in coronary atherosclerosis, presenting multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome, heart failure and sudden cardiac death. Coronary microvasculature consists of vessels with a diameter less than 500 μm, whose potential structural and functional abnormalities can lead to inappropriate dilatation and an inability to meet the required myocardium oxygen demands. This review focuses on the pathogenesis of coronary microvascular dysfunction and the capability of non-invasive screening methods to detect the phenomenon. Anti-inflammatory agents, such as statins and immunomodulators, including anakinra, tocilizumab, and tumor necrosis factor-alpha inhibitors, have been assessed recently and may constitute additional or alternative treatment approaches to reduce cardiovascular events in atherosclerotic heart disease characterized by coronary microvascular dysfunction.

Keywords: anti-inflammatory treatment; atherosclerosis; biomarkers; coronary microvascular dysfunction; imaging; risk factors.

Figure 1

Inflammatory mechanisms of cardiovascular risk factors implicated in coronary microvascular dysfunction. TMAO: trimethylamine N-oxide; NO: nitric oxide.

Figure 2

Anti-inflammatory approaches in cardiovascular diseases. IL: interleukin; NLRP3: NOD-like receptor protein 3; TNF: tumor necrosis factor; CRP: C reactive protein; PAI: plasminogen activator inhibitor; VSMC: Vascular Smooth Muscle Cell; HMG-CoA: 3-hydroxy-3-methylglutaryl-CoA.