Comprehensive treatment of microvascular angina in overweight women - a randomized controlled pilot trial

• Published in: PloS one 2020-11, Vol.15 (11), p.e0240722
• Main Authors: Bove, Kira Bang, Nilsson, Malin, Pedersen, Lene Rørholm, Mikkelsen, Nicolai, Suhrs, Hannah Elena, Astrup, Arne, Prescott, Eva
• Format: Article
• Language: English
• Subjects: Aged; Angina; Angina pectoris; Biology and Life Sciences; Body composition; Body mass; Body mass index; Body size; Body weight; Body weight loss; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular research; Care and treatment; Cholesterol; Combined Modality Therapy - methods; Complications and side effects; Coronary Angiography; Coronary artery; Coronary artery disease; Coronary Circulation - physiology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Diabetes; Diabetes mellitus; Diet, Reducing - methods; Doppler effect; Dyslipidemia; Echocardiography; Energy Intake - physiology; Exercise; Exercise Therapy; Female; Fitness training programs; Flow velocity; Health aspects; Health risks; Heart diseases; Humans; Hypertension; Medical treatment; Medicine and Health Sciences; Mental depression; Methods; Microcirculation - physiology; Microcirculation disorders; Microvascular Angina - diagnosis; Microvascular Angina - etiology; Microvascular Angina - physiopathology; Microvascular Angina - therapy; Microvasculature; Middle Aged; Nutrient deficiency; Nutrition research; Overweight; Overweight - complications; Overweight - physiopathology; Overweight - therapy; Overweight persons; Physical training; Pilot Projects; Proteins; Quality of life; Randomization; Risk analysis; Risk Factors; Risk management; Signs and symptoms; Treatment Outcome; Triglycerides; Weight control; Weight loss; Weight Loss - physiology; Weight Reduction Programs - methods; Women's health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240722

Coronary microvascular dysfunction (CMD) carries a poor cardiovascular prognosis and may explain angina in women without obstructive coronary artery disease (CAD). Currently, no evidence-based treatment for CMD exists. We investigated whether reducing cardiovascular risk factors improves symptoms and microvascular function in women with non-endothelial dependent CMD and no obstructive CAD. We randomized 62 women aged 40-75, with body mass index (BMI) >25 kg/m2, angina ≥monthly, and coronary flow velocity reserve (CFVR) ≤2.5 to a 24-week intervention comprising low energy diet, exercise training, and optimized treatment of hypertension, dyslipidemia and diabetes or to control. Patients were assessed before randomization and after 24 weeks. Primary outcomes were CFVR assessed by transthoracic Doppler stress-echocardiography and angina burden by Seattle Angina Questionnaire (SAQ). Secondary outcomes were exercise capacity, body composition, glycemic control, myocardial function, and anxiety and depression symptoms. Fifty-six participants (90%) completed the study. Median (IQR) age was 65.2 (57.1;70.7) years, BMI was 30.1 (28.4;32.7) kg/m2. The intervention resulted in relevant improvement in angina symptoms (9-21-point increase on SAQ-scales (all p