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Everything To Know About Nonobstructive Coronary Artery Disease
Nonobstructive coronary artery disease (CAD) occurs when the coronary arteries have a plaque buildup but remain unblocked.
Experts usually view it as less severe than obstructive CAD. However, research reveals nonobstructive CAD may also increase the risk of a heart attack.
In this article, we examine the differences between nonobstructive and obstructive CAD. We also discuss whether nonobstructive CAD is dangerous and the potential risk factors and treatments for the condition.
A note about sex and genderSex and gender exist on spectrums. This article will use the terms "male," "female," or both to refer to sex assigned at birth. Click here to learn more.
Nonobstructive CAD differs from obstructive CAD in that people with nonobstructive CAD do not have as much plaque buildup in their arteries.
With obstructive CAD, the plaque buildup is significant (usually greater than 70%) and can narrow or block the arteries. This slows oxygenated blood flow to the heart and raises the risk of a heart attack.
The plaque is still present with nonobstructive CAD. However, it does not block the arteries. For a doctor to diagnose a person with nonobstructive CAD, the plaque must block less than 50% of the arteries.
The evidence points to the possibility that nonobstructive CAD could also be dangerous.
Historically, experts have tended to dismiss nonobstructive CAD as less severe than obstructive CAD because of an assumption that it is the physical blocking of the arteries that leads to a higher risk for heart attack. However, around 5–6% of people who have heart attacks do not have obstructive CAD.
The authors of a 2020 article in the European Heart Journal also note that treating the blockages in people with obstructive CAD is often ineffective in reducing heart attacks from occurring in the future.
The American Heart Association states that nonobstructive CAD is associated with a 28–44% increased risk of a major cardiac event, such as a heart attack or death.
As a result of research findings, experts are looking more closely at the extent of plaque forming in the arteries as a possible indicator of a future heart attack rather than the physical blockage itself.
It is worth noting there are two types of heart attacks.
One type includes heart attacks that occur due to something suddenly blocking blood flow, such as a piece of plaque. The other type is when the amount of blood oxygen required by the body is not supplied. This second type tends to occur with obstructive CAD, while the first type can occur with nonobstructive CAD.
Treatment for nonobstructive CAD depends on whether a person has had a major cardiac event, such as a heart attack, or whether another underlying health condition is present.
Nonobstructive CAD does not block the arteries, so it is unlikely a doctor will recommend surgery. However, if plaque continues to build up, they may suggest surgery.
Surgical interventions to treat obstructive CAD by restoring blood flow to the heart may include:
Experts sometimes view nonobstructive CAD as less severe than obstructive CAD. However, recent research suggests it can also result in major cardiac events.
The symptoms, risk factors, diagnosis, and treatment for nonobstructive CAD are the same as obstructive CAD. However, a person may not require surgery if plaque buildups have not blocked the arteries.
Lifestyle changes and medication to treat risk factors, such as high cholesterol, may help to reduce the risk of a heart attack.
Even Mild Coronary Artery Disease Puts Diabetic Patients At Risk
According to a new long-term study, diabetic patients with even mild coronary artery disease face the same relative risk for a heart attack or other major adverse heart events as diabetics with serious single-vessel obstructive disease. Results of the study were presented today at the annual meeting of the Radiological Society of North America (RSNA).
Researchers at the University of British Columbia and St. Paul's Hospital in Vancouver analyzed data from the Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter (CONFIRM) Registry, which was developed to examine the prognostic value of cardiac computed tomography angiography (CCTA) for predicting adverse cardiac events related to coronary artery disease. The registry, which has CCTA data on 40,000 patients from 17 centers around the world, now has five-year follow-up data on 14,000 patients.
"The CONFIRM Registry is the largest long-term data set available and allowed us to evaluate the long-term prognostic value of CCTA in diabetic patients," said study co-author Jonathan Leipsic, M.D., vice chairman of the Department of Radiology at the University of British Columbia.
The researchers analyzed data on 1,823 diabetic patients who underwent CCTA to detect and determine the extent of coronary artery disease, in which a waxy substance called plaque builds up inside the arteries of the heart. This plaque buildup causes the artery wall to thicken, which limits or, in some cases, completely obstructs blood flow.
Men and women (median age 61.7) in the study were categorized as having no coronary artery disease, mild disease (less than 50 percent of coronary artery narrowed), or obstructive disease (more than 50 percent artery obstruction). Over a 5.2-year follow-up period, there were 246 deaths, representing 13.5 percent of the total study group.
Major adverse cardiovascular event (MACE) data was available on 973 patients. During the follow-up period, 295 (30.3 percent) of the patients experienced a MACE, such as heart attack or a procedure to re-open an obstructed artery called a coronary revascularization.
The researchers found that both obstructive and mild, or non-obstructive, coronary artery disease as determined by CCTA were related to patient deaths and MACE. Most importantly, the study found that the relative risk for death or MACE for a patient with mild coronary artery disease was comparable to that of patients with single vessel obstructive disease.
"Until now, two-year follow-up studies suggested that a diabetic patient with mild or non-obstructive coronary artery disease had a lower risk of major adverse cardiovascular events and death than patients with obstructive disease," said co-author Philipp Blanke, M.D, radiologist at the University of British Columbia and St. Paul's Hospital. "Our five-year follow-up data suggests that non-obstructive and obstructive coronary artery disease as detected by cardiac CTA in diabetic patients are both associated with higher rates of mortality."
Dr. Leipsic said researchers need a better understanding of the evolution of plaque in the arteries and patient response to therapies.
"Cardiac CT angiography is helpful for identifying diabetic patients who are at higher risk for heart events, who may benefit from more aggressive therapy to help modify that risk," added Dr. Leipsic.
What Types Of Coronary Artery Disease Are There?
There are two main types of coronary artery disease (CAD): obstructive coronary artery disease (OCAD) and nonobstructive coronary artery disease (NOCAD). They have similar symptoms but different causes.
CAD affects the coronary arteries, which are blood vessels that supply the heart with oxygen and other nutrients. The two principal coronary arteries are the left and right coronary arteries.
This article explores the different types of CAD in more detail and discusses CAD symptoms, treatment, and prevention.
Obstructive coronary artery disease
In OCAD, atherosclerosis occurs in the coronary arteries. This can reduce or block the flow of blood to the heart muscle, meaning the heart may not receive enough oxygen-rich blood. It can also block blood flow to the rest of the body.
Nonobstructive coronary artery disease
While plaque buildup may occur in NOCAD, healthcare professionals do not define this buildup as significant.
Instead, NOCAD more often occurs due to problems with how the coronary arteries work. For example, damage to the coronary artery walls causes them to tighten suddenly and temporarily narrow. This may occur due to causes such as:
A note about spontaneous coronary artery dissectionSpontaneous coronary artery dissection (SCAD) is not a form of CAD, although it affects the coronary arteries. It is a spontaneous and sudden medical emergency.
Some people may think that SCAD is a type of CAD because they have similar acronyms, but this is not the case.
Instead, SCAD is a medical event in which the innermost layer of the coronary artery suddenly tears without warning, allowing blood to pass into the inner chamber. This can block blood flow to the heart and may lead to a heart attack.
The most common symptom of CAD is angina, which may feel like pain, pressure, or tightness in the chest.
In many cases, people do not know they have CAD until they experience a heart attack. Angina is one possible sign of a heart attack. A person needs to call 911 if they think they or someone else may be experiencing a heart attack.
CAD can weaken the heart muscle. Eventually, this may lead to heart failure, a condition in which the heart does not efficiently pump blood around the body.
Is it a heart attack?Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:
If someone has these symptoms:
If a person stops breathing before emergency services arrive, perform manual chest compressions:
Use an automated external defibrillator (AED) available in many public places:
Healthcare professionals will recommend treatment on an individual basis, depending on the severity of a person's CAD and their overall health. This can include a combination of treatments.
Lifestyle changes
Before suggesting prescription medications or surgical procedures, doctors recommend a person with CAD try:
Medications
They may also prescribe medications to help lower cholesterol and manage blood pressure and weight.
Surgical procedures
Surgical procedures for treating CAD include:
Visit our dedicated hub for more research-backed information and in-depth resources on cardiovascular health.
The two main types of coronary artery disease (CAD) are obstructive coronary artery disease (OCAD) and nonobstructive coronary artery disease (NOCAD).
The primary cause of OCAD is atherosclerosis. NOCAD may involve plaque buildup, but it typically occurs due to issues with how the coronary arteries work. Both types of CAD result in reduced blood flow to the heart, which can lead to a heart attack.
People may not know they have CAD until they experience a heart attack. A person needs to call 911 immediately if they think they or someone else may be experiencing a heart attack.
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