Coronary Vascular Health and Disease Mechanisms

The coronary vasculature comprises large epicardial arteries and a dense network of microvessels that regulate myocardial perfusion in response to metabolic demand. Healthy endothelial and smooth muscle cell function ensures balanced vasodilation and vasoconstriction, while intact vessel integrity prevents thrombosis and dissection. Atherosclerotic plaque formation, microvascular dysfunction and vasospasm represent key pathological processes that disrupt flow, precipitating ischaemia, infarction and heart failure. Genetic predisposition, systemic inflammation, hypertension and metabolic disorders interact to drive disease progression. Recent advances in imaging, invasive physiology and molecular genetics have refined our understanding of epicardial and microvascular disease endotypes, enabling stratified diagnostics and targeted interventions. The global burden of coronary vascular disorders underscores the need for improved prevention and personalised treatment pathways, from novel pharmacotherapies to device-based approaches for refractory angina.

Research from Nature Portfolio

A large genome-wide association meta-analysis of spontaneous coronary artery dissection identified multiple risk loci linked to arterial wall integrity and tissue-mediated coagulation. Several variants clustered in regulatory regions controlling extracellular matrix components and vascular smooth muscle cell function, while one locus encompassing the tissue factor gene suggested a specific coagulation pathway in dissection risk. Notably, some alleles exhibited opposing associations in atherosclerotic coronary artery disease, indicating shared biological processes acting through divergent mechanisms. Mendelian randomisation also inferred a causal role for elevated blood pressure in dissection risk. These insights inform future efforts to develop precision therapies aimed at reinforcing arterial integrity and modulating coagulation cascades in vulnerable individuals.

Coronary Vascular Health and Disease Mechanisms publication trend

The graph below shows the total number of articles in coronary vascular health and disease mechanisms across all publications each year (not limited to Nature Index journals).

Technical terms

Coronary microvascular dysfunction (CMD): Impairment of small‐vessel regulation leading to inadequate myocardial perfusion despite unobstructed epicardial arteries.

Ischaemia with non‐obstructive coronary arteries (INOCA): Clinical syndrome of myocardial ischaemia in the absence of flow‐limiting epicardial stenosis.

Spontaneous coronary artery dissection (SCAD): Acute separation of arterial wall layers causing impaired blood flow and myocardial infarction, often in young women.

Index of microcirculatory resistance (IMR): Invasive wire‐based measure of microvascular resistance during maximal hyperaemia.

Genome‐wide association study (GWAS): Unbiased screen of common genetic variants across the genome to identify loci associated with disease risk.

References

1. Coronary sinus reducer for the treatment of refractory angina (ORBITA-COSMIC): a randomised, placebo-controlled trial. The Lancet (2024).
2. Genome-wide association meta-analysis of spontaneous coronary artery dissection identifies risk variants and genes related to artery integrity and tissue-mediated coagulation. Nature Genetics (2023).
3. Coronary Microvascular Dysfunction. Journal of Clinical Medicine (2020).