3 Things to Know About Coronary Microvascular Dysfunction (CMD): A Heart Condition You’ve Probably Never Heard Of

(BPT) - In a time when health concerns are top of mind, it’s critical to be aware of underlying issues that may be impacting your overall health and quality of life. According to the U.S. Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for women in the United States. One type of heart disease in particular is often overlooked and underdiagnosed.

Coronary microvascular dysfunction (CMD) is a type of non-obstructive coronary artery disease that affects the heart’s smallest arteries causing decreased blood flow to the muscle tissue in the heart.¹ This disease primarily affects younger women, beginning in their 40s¹, with some patients reporting the onset of symptoms as early as their teens or 20s.² Common symptoms include recurring and debilitating chest pain, fatigue and shortness of breath.¹

In February, American Heart Month, it’s vital to learn more about this lesser-known form of heart disease and speak to your doctor if you are experiencing frequent chest pain or other symptoms. He or she can discuss treatment options that may help.

Signs of ‘hidden’ disease

Traditional tests are unable to detect damage caused by CMD.¹ In these patients, the walls of small coronary arteries are damaged or diseased, reducing the flow of blood to the heart muscle.¹ They experience very similar symptoms to more typical coronary artery disease, such as frequent chest pain (also referred to as “angina”) and shortness of breath.¹ The chest pain often occurs during normal daily activities, such as shopping, cooking or going to work.¹

But since standard medical imaging tests are designed to look for blockages in large arteries, the damage to small vessels that characterizes CMD escapes notice.¹ Physicians often assumed patients were instead experiencing an emotional or psychological disturbance.

The lack of effective diagnostic methods means that many patients, especially women, have gone untreated as their condition worsened.^3,4 Proper education and better diagnostic tools are the first steps to improving outcomes in these patients — who are at high risk for serious cardiac events.

Lifestyle critical to symptom relief

Many women have chest pain, poor quality of life, and psychological distress related to CMD.⁵ CMD can also increase risk of cardiac events in the future, including heart failure, heart attack and stroke, similar to patients who have obstructions in large coronary arteries.^6,7 Over 40% of patients are readmitted to the hospital for angina following a CMD diagnosis³ and 30% of them undergo a repeat coronary angiography — an invasive procedure to check for blocked or narrowed blood vessels in your heart.³

Doctors have noted that to improve CMD symptoms, lifestyle changes are critical. These include things like smoking cessation, exercise, stress relief and weight loss.⁵ It is also important to watch out for and control risk factors that can lead to an unhealthy heart, including type 2 diabetes, high blood pressure and high cholesterol.⁸

Treatments on the horizon

Treatment to help relieve CMD symptoms includes many of the standard drugs used to treat ischemia (the restriction of blood supply to tissues), such as beta blockers, calcium antagonists and nitrates.³ However, these treatments often fall short.² Only half of patients typically respond to traditional anti-anginal drugs.³

There are no approved treatments specifically indicated for CMD at this time. However, Caladrius Biosciences, on the heels of very positive results from its Phase 2a, ESCaPE-CMD study, recently initiated a Phase 2b clinical trial (known as the “FREEDOM Trial”) to study a potentially effective treatment for CMD. The FREEDOM Trial is evaluating CLBS16, a type of cell therapy that uses your own cells, specifically, blood vessel forming cells called CD34+ cells, to repair damage to the coronary arteries and stimulate the growth of new blood vessels.

“Despite the latest advances and improvements in stents, surgeries and medicines for those with heart conditions, many patients struggle with debilitating chest pain, which takes a toll on the quality of many lives,” said Timothy Henry, M.D., cardiologist and director of the Lindner Center at The Christ Hospital in Cincinnati. “With the amount of misdiagnosis and the serious health effects caused by CMD, it is critical to speak to your doctor if you’re experiencing frequent chest pain. A doctor may direct you to new and unique options to potentially provide innovative and effective care when possible.”

¹ Coronary microvascular dysfunction in women: an overview of diagnostic strategies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909446/

² Caladrius Biosciences internal database for ESCaPE-CMD Study

³ Microvascular angina: angina that predominantly affects women https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351318/

⁴ Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201435/

⁵ Coronary microvascular dysfunction: an update https://academic.oup.com/eurheartj/article/35/17/1101/2465953

⁶ Syndrome X and Microvascular Coronary Dysfunction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210740/

⁷ Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739787/

⁸ Coronary Microvascular Dysfunction - Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy https://www.jstage.jst.go.jp/article/circj/81/1/81_CJ-16-1002/_html/-char/en