Ischemic heart disease
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Ischemic Heart Disease: An Overview
Introduction to Ischemic Heart Disease
Ischemic heart disease (IHD), also known as coronary artery disease, is a condition characterized by reduced blood flow to the heart muscle due to atherosclerosis or other functional alterations in coronary circulation. This imbalance between oxygen supply and demand can lead to various clinical manifestations, including acute coronary syndromes and chronic coronary syndromes .
Pathophysiology of Ischemic Heart Disease
The pathophysiology of IHD is multifaceted, involving not only atherosclerotic plaque formation but also microvascular dysfunction. While traditionally associated with flow-limiting obstructions in large to medium-sized coronary arteries, recent findings suggest that not all cases are due to severe atherosclerotic plaques. Understanding the diverse mechanisms, from plaque activation to microvascular dysfunction, is crucial for a comprehensive assessment of IHD.
Diagnostic Approaches
Noninvasive Imaging Techniques
Noninvasive imaging plays a pivotal role in diagnosing IHD, especially in symptomatic patients where obstructive disease cannot be excluded by clinical assessment alone. Coronary computed tomography (CT) angiography is recommended as a first-line diagnostic tool due to its high rule-out power. Additionally, functional assessments using noninvasive nuclear or magnetic resonance technology, or CT-based fractional flow reserve (FFR-CT), further qualify the diagnosis .
Treatment Strategies
Conventional Medical Therapy
Optimal medical treatment remains the cornerstone of managing IHD. This includes the use of drug-eluting stents, coronary artery bypass graft surgery, and anti-thrombotic therapies. These conventional treatments aim to stabilize or regress the disease, providing symptom relief and preventing myocardial infarction .
Biopharmaceutical-Based Therapies
Emerging biopharmaceutical-based therapies, such as recombinant protein therapy, gene therapy, and cell transplantation, show promise in inducing neovascularization and improving collateral blood flow in the ischemic heart. These advanced therapies represent a significant shift from traditional surgical approaches, offering new avenues for treatment.
Global Mortality and Trends
IHD remains the leading cause of death worldwide, responsible for millions of deaths annually. However, mortality rates vary significantly between countries. For instance, age-standardized mortality rates are much higher in Ukraine and Kazakhstan compared to the United States, Brazil, and the United Kingdom. Despite these differences, a progressive decline in IHD mortality has been observed globally, attributed to reductions in smoking and hypertension, although rising obesity and type II diabetes mellitus pose new challenges .
Conclusion
Ischemic heart disease is a complex and dynamic condition with significant global health implications. Advances in diagnostic imaging and treatment strategies, including both conventional and biopharmaceutical therapies, offer hope for better management and outcomes. Continued research and public health efforts are essential to further reduce the burden of IHD worldwide.
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