Ischaemic heart disease coronary heart disease
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Understanding Ischaemic Heart Disease and Coronary Heart Disease
Overview of Ischaemic Heart Disease and Coronary Heart Disease
Ischaemic heart disease (IHD) and coronary heart disease (CHD) are often used interchangeably, but they encompass a range of conditions that result from reduced blood supply to the heart muscle. IHD is primarily caused by atherosclerotic coronary artery disease (CAD), which leads to the narrowing or blockage of coronary arteries, impeding blood flow and oxygen delivery to the heart . This condition is a leading cause of death globally, particularly in industrialized nations, where it accounts for a significant proportion of mortality .
Genetic Factors in Ischaemic Heart Disease
Recent research has highlighted the role of genetic variants in the susceptibility to IHD. Specifically, variations in the ATP-sensitive potassium channel (KATP), particularly the Kir6.2 subunit encoded by the KCNJ11 gene, have been implicated. Studies have shown that certain single nucleotide polymorphisms (SNPs) in this gene are associated with different forms of IHD, including coronary artery disease and coronary microvascular dysfunction. For instance, the rs5215 G/G variant appears to be a protective factor against IHD, suggesting potential avenues for gene therapy in the future.
Gender Differences in Ischaemic Heart Disease
There are notable gender differences in the presentation, mechanisms, and outcomes of IHD. Women tend to develop IHD later in life compared to men and often present with nonobstructive epicardial artery disease, stress cardiomyopathy, and microvascular dysfunction. Despite these differences, women generally have worse outcomes, including higher in-hospital mortality rates after acute myocardial infarction, particularly among younger women. These disparities underscore the need for gender-specific approaches in the diagnosis and management of IHD.
The Role of Mental Stress in Ischaemic Heart Disease
Mental stress is increasingly recognized as a significant factor in IHD, particularly in cases where no obstructive coronary artery disease is present (INOCA). Psychological stress can exacerbate coronary microvascular dysfunction and coronary vasomotor disorders, leading to adverse cardiovascular outcomes. This is especially prevalent in women, who are more likely to experience stress-induced endothelial dysfunction. Addressing psychological stress through targeted therapies could improve outcomes for patients with INOCA.
Advances in Diagnostic and Therapeutic Approaches
Recent advancements in diagnostic techniques have improved the ability to assess and manage IHD. For example, a novel method for measuring absolute coronary blood flow and microvascular resistance has been developed, allowing for more accurate assessment of both epicardial and microvascular disease during routine catheter laboratory procedures. This method enhances patient stratification and could lead to more personalized treatment strategies.
Conclusion
Ischaemic heart disease and coronary heart disease remain major health challenges worldwide. Understanding the genetic factors, gender differences, and the impact of mental stress on these conditions is crucial for developing effective diagnostic and therapeutic strategies. Advances in medical technology and personalized approaches hold promise for improving patient outcomes and reducing the global burden of these diseases.
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