Did you know that 50% of women that come into the emergency room with chest pain have minimal or no blockages? And many are reassured they are okay when they’re not?
And when they do undergo further testing, it is discovered that 53% of them have coronary microvascular disease (CMD).
This is a topic I wish I saw more in the midlife and menopause world. After all, risk of CMD rises at midlife and with aging, and it’s more common in women than men.
The microvascular system comprises the small blood vessels, including arterioles and capillaries. Most of the research and diagnostic criteria relate to large arteries termed coronary artery disease (CAD). Yet the research is scant on the small blood vessels—hence why no one really talks about it.
Last year I posted about a research gem on estrogen’s effect on the microvascular system. It led me to work of Julie Freed, MD, PhD and the Freed Lab at the Medical College of Wisconsin. Dr Freed specializes in providing anesthesia for patients with advanced cardiac disease. She is also a physician scientist whose lab focuses on understanding microvascular dysfunction, the precursor to CAD.
I've dug deep to understand how estrogen affects vascular health and her research is the most innovative I've seen. In fact, this research at the Freed lab may change the course of how we look at estrogen’s effect on the heart. Moreover, it can provide valuable insights for optimizing menopausal hormone therapy, gender-affirming therapy, hormonal contraception, and inform research on risk-reducing lifestyle strategies.
Endothelial dysfunction is the beginning of cardiovascular disease. But I study it in the microcirculation because those become dysfunction well before you have large artery disease.
Here are some things we talk about:
The vital importance of endothelial cells in vascular health.
Why endothelial dysfunction as the initiating step in heart disease, and how microvascular issues often precede coronary artery disease.
The significance of small arteries relying on an alternative dilation mechanism [hydrogen peroxide] rather than nitric oxide.
The problem of testing and early diagnostic criteria for CMD—unfortunately coronary calcium score does not get at it.
A surprising finding about estrogen's influence on the microvascular system that was made by the Freed Lab.
The follow up research that is being done to get answers of this research that is still in its infancy.
What women can do to help decrease their risk of microvascular dysfunction.
Links
The Most Unnoticed Midlife Research Gem of 2023
The Gaping Hole in Women’s Health Research
Estrogen and the Vascular Endothelium: The Unanswered Questions
17-B estradiol promotes sex-specific dysfunction in isolated arterioles
Abstract 12494: Role of ceramide in estrogen-induced oxidative stress in endothelial cells from individuals
The Microvascular System, Estrogen, and Women's Health with Dr. Julie Freed