A couple of days ago, I updated you on my neighbor Jean who has heart artery disease and repeated chest pain, but no blockages. Yesterday, I showed you pictures from an arterial ultrasound that showed cholesterol plaque deposits throughout the arteries of a woman with no blockages. Inflammation in these cholesterol deposits causes microabscesses to burst open and expose a raw arterial surface. That initiates the clotting process and some of these clots totally block the artery causing a heart attack. Women are more likely to have chest pain without fixed blockages.
Most heart attacks occur in an artery that is less than 50% obstructed prior to the heart attack. There were 4 studies, summarized in Circulation in 1995, reporting on patients who had a heart attack, and they had had a catheterization in the year or two before. In two thirds of the cases, the artery causing the heart attack was less than 50% blocked previously. We have known that heart attacks occur in non-obstructed arteries for 25 years. That is almost certainly how heart attacks occur in people like Jean.
The latest reseach points to coronary microvascular disease (CMD)which contributes to poor blood flow as a major factor in these patients. CMD is related to arterial damage which reduces nitric oxide (NO) production. Nitric oxide is the active ingredient in nitroglycerin. NO maintains arterial health and it causes the artery to dilate or expand. Stimuli that cause the artery to dilate in healthy people may produce spasm and narrowing in women with repeated chest pain because of their nitric oxide deficiency.
Optimal medical therapy stabilizes plaque so that it does not rupture or erode and cause a clot leading to a heart attack. It also mitigates coronary microvascular disease by improving artery function and increasing nitric oxide production. I have treated 25 women like this with optimal medical therapy. After a couple of months of treatment, I don’t remember a single one having a heart related ER visit or hospitalization. None of them had a heart attack and none of them died. Making high-quality optimal medical therapy widely available should be a major national priority. It is not that hard. Let’s do it!
https://youtu.be/e7GDFuVEMn8
Jean’s case demonstrates the fundamental need for effective lifestyle optimization prevention measures. If these measures are inadequate, measured using Multifunction Cardiogram Technology objectovely, transparently, and quatitatively, then escalation to Optimal Medical Therapy is the next logical step. One can chose to do both simultaneously of course.