From the Guidelines
The treatment of chronic microvascular disease should prioritize intensive management of hyperglycaemia and hypertension to reduce the risk of microvascular complications and cardiovascular disease. This approach is supported by the European guidelines on cardiovascular disease prevention in clinical practice, which emphasize the importance of controlling risk factors to prevent microvascular disease progression 1.
Key Components of Treatment
- Intensive management of hyperglycaemia in diabetes to reduce the risk of microvascular complications, as recommended by the European guidelines 1
- Intensive treatment of blood pressure in diabetes to reduce the risk of macrovascular and microvascular outcomes, which may require multiple antihypertensive drugs to reach the target 1
- Lifestyle modifications, including regular exercise, weight management, smoking cessation, and a heart-healthy diet low in sodium and saturated fats
- Medication therapy, such as antihypertensives, to maintain blood pressure below 130/80 mmHg, with ACE inhibitors or ARBs as first-line options
- Tight glycemic control for diabetic patients, aiming for HbA1c below 7%, using medications like metformin
- Statins to maintain LDL cholesterol below 70 mg/dL
- Antiplatelet therapy with aspirin for secondary prevention
Symptom Management and Monitoring
- Medications targeting specific manifestations, such as calcium channel blockers for Raynaud's phenomenon or pentoxifylline for claudication
- Regular monitoring of organ function, as microvascular disease can affect multiple systems, including the heart, kidneys, eyes, and nervous system
- Addressing the underlying pathophysiology of endothelial dysfunction, inflammation, and oxidative stress that contribute to microvascular damage and progression 1
From the Research
Treatment Options for Chronic Microvascular Disease
- Treatment of cardiovascular risk factors is essential in managing chronic microvascular disease, as evidenced by studies 2, 3, 4.
- Antianginal therapy is also a crucial component of treatment, with recent evidence suggesting that stratifying antianginal therapies according to the diagnosis revealed by invasive assessment of the coronary microcirculation can improve patient outcomes 2, 3.
- Therapy for atherosclerosis is another important aspect of treatment, as it can help to reduce the risk of adverse cardiovascular outcomes 2, 3, 4.
- Targeting inflammatory pathways is also a proposed mechanism for treating chronic microvascular disease, with imaging modalities such as echocardiography, cardiac MRI, PET, and CT being useful in diagnosing the disease 4.
- Statins, ACE inhibitors, and ARBs have been shown to be effective in reducing cardiovascular disease, and may also be beneficial in treating chronic microvascular disease 5.
Diagnostic Modalities
- Invasive measurements through thermodilution and pressure sensor-guided Doppler microcatheters have been utilized to diagnose chronic microvascular disease 4.
- Noninvasive techniques for measuring human microcirculation, such as endothelium-dependent (micro)vascular reactivity, can also be used to assess microvascular function 6.
- Imaging modalities such as echocardiography, cardiac MRI, PET, and CT can be used to assess coronary blood flow and diagnose chronic microvascular disease 4.
Management of Chronic Microvascular Disease
- Management of chronic microvascular disease involves a multifaceted approach, including treatment of cardiovascular risk factors, antianginal therapy, and therapy for atherosclerosis 2, 3, 4.
- Targeting inflammatory pathways and endothelial dysfunction is also an important aspect of treatment, with various mediators such as nitric oxide, endothelin, and prostanoids playing a role in microvascular function 6.