Overview
Non-obstructive atherosclerosis of coronary arteries refers to atherosclerotic disease without significant luminal stenosis, often manifesting as ischemia and non-obstructive coronary artery disease (INOCA), potentially due to coronary microvascular dysfunction (CMD) or vasospastic angina (VSA). 1Diagnosis
Key Diagnostic Criteria: Identification of ischemia in the absence of significant coronary artery stenosis.
Recommended Tests:
- Coronary angiography to rule out obstructive CAD.
- Functional assessments such as stress echocardiography or myocardial perfusion imaging.
- Biomarker analysis, including extracellular vesicles (EVs) for differentiating INOCA endotypes.
Grading: Utilize imaging findings and clinical symptoms to classify into CMD, VSA, or mixed endotypes based on EV ratios (e.g., CD144+ EVs to total EVs). 1Management
First-Line Treatments:
- Lifestyle modifications including diet, exercise, and smoking cessation.
- Antiplatelet therapy (e.g., aspirin).
Adjunctive Treatments:
- Optimizing blood pressure control with ACE inhibitors or ARBs.
- Cholesterol management with statins.
- Beta-blockers for symptom control in vasospastic angina.
Specific Drug Classes/Doses: Not specified in the provided abstracts.Special Populations
Pregnancy: Limited data; management focuses on symptom control and risk factor modification. [No specific evidence in provided abstracts]
Pediatrics: Not addressed in the provided abstracts.
Elderly: Tailored approach focusing on multimorbidity management and fall prevention alongside cardiovascular risk reduction. [No specific evidence in provided abstracts]
Comorbidities: Management should consider coexisting conditions like hypertension and diabetes, emphasizing comprehensive risk factor control. [No specific evidence in provided abstracts]Key Recommendations
Utilize extracellular vesicle analysis, particularly the ratio of endothelial EVs (CD144+) to total EVs, to differentiate between INOCA endotypes for personalized management strategies. (Evidence: Moderate) 1
Employ functional testing (e.g., stress echocardiography) alongside coronary angiography to diagnose non-obstructive coronary atherosclerosis accurately. (Evidence: Moderate) 1
Implement comprehensive lifestyle modifications and pharmacological interventions targeting risk factors such as hypertension, hyperlipidemia, and diabetes in patients with non-obstructive atherosclerosis. (Evidence: Expert opinion) [No specific evidence in provided abstracts]References
1 Gąsecka A, Szolc P, van der Pol E, Niewiara Ł, Guzik B, Kleczyński P et al.. Endothelial Cell-Derived Extracellular Vesicles Allow to Differentiate Between Various Endotypes of INOCA: A Multicentre, Prospective, Cohort Study. Journal of cardiovascular translational research 2025. link
2 Wolverson MK, Nouri S, Joist JH, Sundaram M, Heiberg E. The direct visualization of blood flow by real-time ultrasound: clinical observations and underlying mechanisms. Radiology 1981. link