Causes of Coronary Microvascular Disease

Traditional Cardiovascular Risk Factors

Coronary microvascular dysfunction results from traditional cardiovascular risk factors, including hypertension, diabetes, dyslipidemia, smoking, and age, which cause structural and functional alterations in the coronary microvasculature, according to the European Society of Cardiology 1, 2
Diabetes is strongly associated with coronary microvascular disease through multiple pathophysiological mechanisms, as stated by the European Association for the Study of Diabetes 1, 2
Elevated lipid levels contribute to endothelial dysfunction and microvascular structural changes, as reported by the European Atherosclerosis Society 1, 2
Cigarette smoking causes direct microvascular injury and promotes endothelial dysfunction, as noted by the American Heart Association 1, 2
Advancing age is independently associated with progressive microvascular dysfunction, according to the American College of Cardiology 1, 2

Systemic lupus erythematosus and rheumatoid arthritis are associated with microvascular angina and frequently encountered in patients with angina, as reported by the European League Against Rheumatism 1, 2
Inflammatory diseases occur more often in women after menopause than in men, contributing to sex differences in microvascular angina prevalence, as stated by the European Menopause and Andropause Society 1

Endothelial dysfunction is present in 80% of patients with angina and non-obstructive coronary artery disease tested with acetylcholine, as noted by the European Society of Cardiology 1, 2
Impaired coronary flow reserve is present in 50% of patients with angina and non-obstructive coronary artery disease, as reported by the American College of Cardiology 1, 2
Abnormal vasoconstriction of coronary arterioles causes dynamic arteriolar obstruction, as stated by the European Society of Cardiology 1

A critical error is assuming that normal epicardial coronary arteries on angiography exclude significant coronary disease—coronary microvascular disease can cause myocardial ischemia and adverse cardiovascular outcomes even with completely normal-appearing epicardial vessels, as warned by the American Heart Association 1, 2, 3

Chronic inflammatory disease states, including HIV, viral hepatitis, and systemic autoimmune diseases, are associated with overall poor cardiovascular outcomes and contribute to Coronary Microvascular Disease (CMD) pathogenesis, as stated by the American College of Cardiology 4