Materiały źródłowe

• #1 Small vessel disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123

  The goals of treatment for small vessel disease are to control the narrowing of the small blood vessels that can lead to a heart attack and to relieve pain. […] Medications for small vessel disease may include: […] Nitroglycerin (Nitrostat, Nitro-Dur). Nitroglycerin tablets, sprays and patches can ease chest pain by relaxing the coronary arteries and improving blood flow. […] Beta blockers. These drugs slow the heart rate and decrease blood pressure. […] Calcium channel blockers. These drugs relax the muscles around the coronary arteries and cause the blood vessels to open, increasing blood flow to the heart. Calcium channel blockers also help control high blood pressure and coronary artery spasms. […] Statins. These medications help lower bad cholesterol, which contributes to the narrowing of the arteries. Statins also help relax the blood vessels of the heart and treat blood vessel damage.

• #2 Small vessel disease // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/small-vessel-disease

  Small vessel disease is treatable but may be difficult to detect. […] The goals of treatment for small vessel disease are to control the narrowing of the small blood vessels that can lead to a heart attack and to relieve pain. […] Medications for small vessel disease may include: Nitroglycerin (Nitrostat, Nitro-Dur). Nitroglycerin tablets, sprays and patches can ease chest pain by relaxing the coronary arteries and improving blood flow. […] Beta blockers. These drugs slow the heart rate and decrease blood pressure. […] Calcium channel blockers. These drugs relax the muscles around the coronary arteries and cause the blood vessels to open, increasing blood flow to the heart. Calcium channel blockers also help control high blood pressure and coronary artery spasms. […] Statins. These medications help lower bad cholesterol, which contributes to the narrowing of the arteries. Statins also help relax the blood vessels of the heart and treat blood vessel damage.

• #3 Small Vessel Disease: Symptoms, Causes, Diagnosis, and Treatments

  https://www.healthline.com/health/small-vessel-disease

  Primary treatment options for small vessel disease involve medications that relieve pain, treat risk factors, and manage associated symptoms. These medications can improve arterial blood flow and prevent heart attacks. […] Some common medications are: Aspirin can help with inflammation and clotting. Nitroglycerin can help improve blood flow and relax coronary arteries. Beta-blocker therapy can slow the heart rate and decrease blood pressure. ACE-inhibitor therapy can help lower blood pressure and open up blood vessels. Statin therapy can help treat and relax blood vessels. Calcium channel blockers can help relax the muscles surrounding coronary arteries, which can help increase blood flow. Ranolazine can help ease chest pain. […] Some lifestyle changes may help treat and manage small vessel disease: maintaining a healthy weight that’s right for you, getting regular exercise, quitting smoking if you smoke, eating a nutrient-dense diet, which includes whole grains, lean proteins, and lowering salt intake.

• #4 Microvascular Ischemic Disease – Symptoms | Causes | Diagnosis | Treatment | Prevention

  https://www.icliniq.com/articles/heart-circulatory-health/microvascular-ischemic-disease

  How Is Microvascular Ischemic Disease Treated? Treatment is done to manage the risk factors that contribute to this condition. It includes: […] The medications used are: Nitroglycerin to ease chest pain. Beta-blockers like Propranolol Bisoprolol to treat hypertension. Angiotensin II receptor blockers (ARBs) such as Azilsartan help relax your blood vessels and lowers blood pressure. Calcium channel blockers like Verapamil and Diltiazem to increase blood flow to the heart and control high blood pressure. Ranolazine helps relieve chest pain by regulating the sodium and calcium levels. Aspirin to prevent blood clots. Statins like Atorvastatin and Simvastatin to lower cholesterol. Angiotensin-converting enzyme (ACE) inhibitors like Benazepril and Lisinopril for hypertension. […] Yes, it can be cured by managing the risk factor associated with microvascular illness. It includes:- Use diet, exercise, and medicine to treat hypertension.- The cholesterol level is decreased by diet, exercise, and medications.- Using medication to reduce homocysteine levels.- To prevent strokes by using blood-thinning medication.- To stop smoking.

• #5 Small vessel disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123

  ACE inhibitors and ARBs. Drugs called angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) help open blood vessels and lower blood pressure. This makes it easier for the heart to pump blood. […] Ranolazine (Ranexa). This medication eases chest pain by altering sodium and calcium levels. […] Aspirin. Aspirin can limit inflammation and prevent blood clots. […] Metformin. This drug is typically prescribed to lower blood sugar in people with diabetes, but it can improve blood vessel health even in those who don’t have diabetes. […] If you’re diagnosed with small vessel disease, you’ll need regular checkups with your health care provider.

• #6 Small Vessel Disease Treatment – Prof. Dr. Dilek Necioğlu Örken | Turkey

  https://www.dilekneciogluorken.com/en/small-vessel-disease-treatment/

  Treating and controlling risk factors is the most important step for the prevention of small vessel disease. If the person has had a lacunar stroke, blood thinners can be started. Studies are still underway on other treatments.

• #7 Two cardiovascular medicines were well-tolerated for small vessel stroke | American Heart Association

  https://newsroom.heart.org/news/two-cardiovascular-medicines-were-well-tolerated-for-small-vessel-stroke

  No standard medical therapy exists for a stroke occurring in a small vessel in the deep areas of the brain called a lacunar stroke. […] A preliminary study of two common cardiovascular medications, cilostazol and isosorbide mononitrate, suggests these two medications were safe and well-tolerated by adults who have experienced small vessel stroke, when taken alone or together. […] A larger, more extensive study is planned to examine the effectiveness of the medications in treating the complications of small vessel stroke. […] Currently, there is no proven treatment to prevent poor outcomes after lacunar stroke, so the ultimate goal with this research is to evaluate if medications with potential modes of action on the inner lining of blood vessels might help improve small vessel function and prevent or slow long-term brain damage after lacunar stroke.

• #8 Two cardiovascular medicines were well-tolerated for small vessel stroke | American Heart Association

  https://newsroom.heart.org/news/two-cardiovascular-medicines-were-well-tolerated-for-small-vessel-stroke

  The medications in the study are commonly prescribed for other cardiac conditions. […] This study, called LACunar Intervention Trial 2 (LACI-2), is the second largest ever trial in lacunar stroke. […] Researchers also saw some potential benefits from the medication groups, including data that indicated the group who took the combined isosorbide mononitrate and cilostazol had a reduction in the amount of assistance they needed with everyday living tasks, a reduction in cognitive impairment and positive impacts on mood and quality of life. […] Isosorbide mononitrate alone reduced recurrent stroke, cognitive impairment and improved quality of life; cilostazol alone reduced the need for daily assistance. […] There appeared to be some potential benefits that will need to be confirmed in a larger phase 3 trial.

• #9 Developing treatments for cerebral small vessel… | F1000Research

  https://f1000research.com/articles/13-1546

  The LACI-1 and LACI-2 trials showed that ISMN was feasible to take (given with or without cilostazol) for up to a year, was safe and improved cognition and functional outcome and reduced recurrent stroke, especially when given with cilostazol. […] Hence, it would now be inappropriate to test either of these drugs in a UK platform.

• #9 Developing treatments for cerebral small vessel… | F1000Research

  https://f1000research.com/articles/13-1546

  Cerebral small vessel disease (cSVD) is a progressive neurovascular-degenerative condition without specific treatment that causes lacunar stroke, most intracerebral haemorrhage, vascular cognitive impairment (VCI) and several neuropsychiatric conditions. […] Unfortunately, cSVD has no specific proven preventative or restorative interventions and lowering blood pressure only has a very limited effect. […] Recently, a phase-2 feasibility trial after lacunar stroke found that isosorbide mononitrate (ISMN), especially when given with cilostazol, improved cognition and functional outcome and reduced recurrent stroke. […] Hence, an increasingly common approach to identifying interventions for testing in neurodegenerative conditions such as cSVD, Alzheimers disease, multiple sclerosis and motor neuron disease are structured systematic approaches that identify candidate treatments on the basis of their known mechanisms of action and existing pre-clinical and clinical studies.

• #10 Developing treatments for cerebral small vessel… | F1000Research

  https://f1000research.com/articles/13-1546

  The preclinical review created a long-list of 1,757 deduplicated interventions. […] Focussed literature review short-listed ten interventions for review by an independent scientific advisory group; they ranked three as most suitable for immediate testing: metformin, tadalafil and isosorbide mononitrate. […] This rapid review identified three interventions that are suitable for testing in a late phase-3 (platform) trial involving patients with cSVD. […] The second ranked drug, tadalafil, is a phosphodiesterase5 inhibitor (PDE5-i) that maintains cyclic guanosine monophosphate levels, the second messenger for nitric oxide. […] The meta-analysis showed that both the odds ratio (7.91) and lower 95% CI (3.76) for PDE5-i were well above the target platform odds ratio of 1.40. […] Of the three drugs, ISMN is the only one to have been tested in cSVD, specifically in patients with previous lacunar infarction.

• #11 Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4832291/

  Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. […] Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. […] Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. Potential interventions include endothelin antagonists, neurotrophins, nitric oxide donors and phosphodiesterase 5 inhibitors, peroxisome proliferator-activated receptor gamma agonists, and prostacyclin mimics and phosphodiesterase 3 inhibitors.

• #12 Antihypertensive drugs could treat cerebral small vessel disease

  https://www.drugtargetreview.com/news/99511/antihypertensive-drugs-could-treat-cerebral-small-vessel-disease/

  The antihypertensive drug candesartan cilexetil reduced matrisomal protein accumulation in mice with cerebral small vessel disease. […] According to the researchers, this discovery opens up a promising new avenue for the treatment of age-related cerebral arteriopathy. […] The results, detailed in the Journal of Clinical Investigation, showed that candesartan treatment reduced matrisomal protein accumulation and normalised vascular stiffness and cerebral blood flow regardless of its antihypertensive effect. […] A protective strategy for cerebral blood vessels to prevent matrisome accumulation with inexpensive oral drugs could be a major change for age-related brain diseases, concluded Onodera.

• #13 Cerebral Small Vessel Disease Treatment With Stem Cells | Swiss Medica

  https://www.startstemcells.com/cerebral-small-vessel-treatment.html

  Due to the chronic nature of the disease, small vessel disease treatment should be prolonged to prevent vascular diseases, such as ischemic stroke. […] However, traditional means do not allow for the effective restoration of damaged neurons, while neurotrophic factors from stem cells are capable of doing so. Additionally, growth factors from stem cells promote the formation of small blood vessels, which is pathogenetic therapy and contributes to increased oxygen flow to the brain. […] Stem cell therapy is a promising treatment that uses stem cells to help repair damaged tissues and promote regeneration. […] In the case of cerebral small vessel disease treatment, mesenchymal stem cells can potentially: Protect cerebral microvessels, neurons, and white matter; Improve blood flow; Reduce inflammation; Alleviate symptoms; Slow down disease progression.

• #14 Small Vessel Disease

  https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/small-vessel-disease/

  The treatment for small vessel disease involves medications to control the narrowing of your small blood vessels that could lead to a heart attack and to relieve pain. Treatment options include: […] Lifestyle Changes […] Avoid smoking. […] Eat a heart-healthy diet. […] Exercise under the directions of your doctor. […] If you’re overweight, talk to your doctor about weight-loss options. […] Manage stress. […] Make and keep appointments to see your doctor for routine check-ups and follow-up tests. […] Medications […] Aspirin will treat pain, inflammation, and reduce risk of a heart attack. […] Vasodilators will help the muscle in the walls of the blood vessels to relax, allowing the vessel to dilate. […] ACE inhibitors will help blood vessels relax and open up, leading to a lower blood pressure. […] Beta blockers will help reduce your blood pressure.

• #15 Cerebral Small Vessel Disease | Symptoms, Diagnosis, Advice and More | 2024 – Pure Medical

  https://pure-medical.co.uk/cerebral-small-vessel-disease-2

  Although there is no known cure for Cerebral Small Vessel Disease, there are therapies that can help you manage your symptoms. Physical therapy is the main course of treatment. If you experience any balance or walking issues, physical therapy can assist. When you can move around more easily and without much help, your general physical and mental health will also improve. […] Treatment usually entails reducing the risk factors that contribute to brain small blood vessel damage. Your doctors treatment method will be determined by your specific risk factors, but it may include: […] Diet, exercise, weight loss, and medication can all help you lower your blood pressure. For adults over 60, the goal is to keep their systolic blood pressure (the top number) below 150. Using prescribed blood pressure medication as needed can delay the diseases course and your symptoms.

• #15 Cerebral Small Vessel Disease | Symptoms, Diagnosis, Advice and More | 2024 – Pure Medical

  https://pure-medical.co.uk/cerebral-small-vessel-disease-2

  Take aspirin or blood-thinning drugs to prevent strokes. […] Hyperbaric Oxygen Therapy (HBOT) for cerebral small vessel disease is that increasing the supply of oxygen to the parts of the brain affected by SVD may lessen brain swelling and protect brain cells, reducing the extent of irreversible brain damage and leading to better outcomes. […] Ozone therapy is currently being used in the treatment of ischemic disorders such as Cerebral Small Vessel Disease. […] Red Light Therapy and near-infrared light photons penetrate through the skull and into brain cells and spur the mitochondria to produce more ATP. […] Infrared sauna therapy Photons penetrate through the skull and into brain cells and spur the mitochondria to produce more ATP.

• #16 Cerebral Small Vessel Disease: What to Know & What to Do

  https://betterhealthwhileaging.net/cerebral-small-vessel-disease/

  For now, to prevent the occurrence or progression of cerebral small vessel disease, its reasonable to start by observing the hypertension guidelines considered reasonable for most older adults: treat to a target of systolic blood pressure less than 150mm/Hg. […] Whether to treat high blood pressure and other cardiovascular risk factors more aggressively should depend on an older persons particular health circumstances.

• #17 Small vessel disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/symptoms-causes/syc-20352117

  Control blood sugar. Work with your health care provider to establish blood sugar goals that are right for you. […] Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, listening to music and connecting with others in support groups are some ways to reduce stress.

• #17 Small vessel disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/symptoms-causes/syc-20352117

  Small vessel disease is treatable but may be difficult to detect. […] Small vessel disease is more common in women and in people who have diabetes or high blood pressure. […] If you’ve been treated for coronary artery disease with angioplasty and stents and your signs and symptoms haven’t gone away, you might also have small vessel disease. […] Things you can do that might reduce your risk of small vessel disease include: […] Manage cholesterol. Ask your health care provider how often you should have your cholesterol numbers checked. If your bad cholesterol (low-density lipoprotein cholesterol) levels are high, your health care provider may prescribe changes to your diet and medications to help lower your cholesterol levels and protect your cardiovascular health. […] Control blood pressure. Ask your health care provider how frequently you should have your blood pressure measured. He or she might recommend more-frequent checks if you have high blood pressure or a history of heart disease.

• #18 Small vessel disease // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/small-vessel-disease

  ACE inhibitors and ARBs. Drugs called angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) help open blood vessels and lower blood pressure. This makes it easier for the heart to pump blood. […] Ranolazine (Ranexa). This medication eases chest pain by altering sodium and calcium levels. […] Aspirin. Aspirin can limit inflammation and prevent blood clots. […] Metformin. This drug is typically prescribed to lower blood sugar in people with diabetes, but it can improve blood vessel health even in those who don’t have diabetes. […] If you’re diagnosed with small vessel disease, you’ll need regular checkups with your health care provider. […] Sometimes, the dietary supplement L-arginine may benefit people with small vessel disease who haven’t been helped by other medications. L-arginine is an amino acid that helps relax blood vessels.

• #19 Small is big: the need for a holistic approach to manage cerebral small vessel disease | EurekAlert!

  https://www.eurekalert.org/news-releases/680305

  Cerebral small vessel disease (SVD) is characterized by damage to the blood vessels and parenchyma in the brain. […] Therefore, accurate diagnosis at an early stage of disease progression helps in defining better prognosis and management strategies for patients with cerebral SVD. […] This review, now published in the Chinese Medical Journal, recommends a holistic, multidisciplinary assessment of individual needs in patients suspected to have SVD. […] The complexity of cerebral SVD is attributable not only to its wide range of symptoms and associated risk factors but also to the unavailability of a concrete therapeutic intervention for patients. Lifestyle changes like regular exercise, smoking cessation, and some kind of resistance training have shown positive effects in patients with SVD.

• #20 Small is big: the need for a holistic approach to manage cerebral small vessel disease | EurekAlert!

  https://www.eurekalert.org/news-releases/680305

  Prof. Wardlaw emphasizes, „Encouragingly, exercise and a healthy Mediterranean diet with folic acid and vitamin B12, combined with guideline-based vascular risk reduction through drugs, has been shown to slow cognitive decline in older people with cerebral SVD.” […] Trials on medications and modifiable as well as non-modifiable risk factors and a combination of these may help in a proper intervention. […] The researchers are hopeful that advanced preclinical, neuroimaging, and pathological research methods will help in finding an effective treatment for cerebral SVD. […] A holistic, multi-pronged approach is therefore essential to understand and deal with the progressive deterioration of neurological and overall health associated with cerebral SVD.

• #21

  https://advances.umw.edu.pl/en/article/2021/30/3/349/

  At the moment, there is no specific treatment available for genetic forms of CSVD. Only for Fabry disease is there a replacement therapy based on intravenously administered -galactosidase A, which is taken up by cells and tissues by the mannose-6-phosphate receptor pathway and delivered to lysosomes. There are no established therapeutic strategies for either preventing or treating sporadic CSVD. Potential prophylactic and treatment strategies might include those that target brain microvascular endothelium and the blood-brain barrier, microvascular function, and neuroinflammation. Because CSVD and ischemic stroke are presumed to share the same pathology, the diagnostic and therapeutic approaches should be the same. For all patients with CSVD, we should assess common vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, and smoking. The treatment is based primarily on the fight against vascular risk factors and primary and secondary prevention of vascular events. One of the most important modifiable risk factors is hypertension. Non-pharmacological treatment is also important and includes diet, sodium restriction, increased physical activity, and abstaining from smoking. Genetic testing should be considered in young people with extensive CSVD in the absence of sufficient conventional vascular risk factors. A closer understanding of the mechanisms leading to damage of small blood vessels may be associated with new therapeutic approaches.

• #22 Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01682-w

  Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases. However, the benefits of statin therapy for cerebral small vessel disease (CSVD), particularly in adults 75 years of age, have not been fully evaluated. […] Our findings indicated that statin therapy alleviated the progression of WMH, lacunes, and EPVS without elevating the risk of microbleeds. On the basis of the observed results, we concluded that statin therapy is an efficient and safe intervention for CSVD in adults 75 years of age. […] Statin therapy was associated with lower risk of WMH, lacunes, and EPVS progression than the non-statin therapy group after adjustment for confounders (all P<0.05). [...] The risks of the progression of WMH, lacunes, and EPVS were significantly lower in the statin group than the non-statin group.

• #23 Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01682-w

  The risks of progression of WMH, lacunes, and EPVS were significantly lower in the rosuvastatin group than the placebo group after adjustment for confounders including the mean and SD of systolic and diastolic blood pressure within the follow-up duration, and incident stroke. […] We found that statin therapy markedly ameliorated the risks of WMH, lacunes, and EPVS progression; and statin therapy had neither beneficial nor detrimental effects on microbleed progression.

• #24 Microangiopathy – Wikipedia

  https://en.wikipedia.org/wiki/Microangiopathy

  Young people with extensive CSVD and few or no conventional vascular risk factors may benefit from genetic testing to identify any underlying genetic disorders that may be contributing to their condition (For Fabry disease, there is an enzyme replacement therapy). […] A better understanding of the mechanisms leading to damage of small blood vessels may be associated with novel therapeutic approaches, the safety and efficacy of some of which will need to be further investigated. Examples include calcium dobesilate and aldose reductase inhibitors in diabetic microangiopathies and endothelin receptor antagonists for pulmonary hypertension.

• #24 Microangiopathy – Wikipedia

  https://en.wikipedia.org/wiki/Microangiopathy

  Treatment options of microangiopathies can be directed at: […] Prevention (e.g. maintaining good glycaemic control, screening for retinopathy and neuropathy and testing for albuminuria). […] Controlling symptoms and preventing further deterioration (e.g. tricyclic antidepressants and gabapentin for diabetic neuropathy). […] Drug therapy (e.g. antiplatelets (low-dose aspirin) and lipid-lowering therapy (statins) for management of CMDs). […] Diet and lifestyle modification (e.g. low-protein diet in diabetic nephropathy, smoking cessation, weight loss, improved nutrition, and regular exercise). […] Intensive management of coexisting conditions and risk factors (e.g. adequate control of blood pressure, diabetes and related metabolic abnormalities and lipid management). […] Other measures (e.g. photocoagulation in patients with severe proliferative diabetic retinopathy).

• #25 Spotlight Series | Microvascular Dysfunction Treatment Options For Coronary Microvascular Dysfunction

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/11/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Treatment-Options-For-Coronary-Microvascular-Dysfunction

  Spotlight Series | Microvascular Dysfunction Treatment Options For Coronary Microvascular Dysfunction […] Treatment Options For Coronary Microvascular Dysfunction […] Despite these findings and increased attention, guideline-based treatment recommendations directed at CMD are lacking. […] CMD is prevalent in hypertension, cardiomyopathies (hypertrophic, ischemic and nonischemic), diabetes, metabolic syndrome, chronic kidney disease, cancer chemotherapy and several other conditions. It is increasingly recognized as an important contributor to myocardial ischemia, in the presence and absence of epicardial coronary atherosclerosis, that is either obstructive or nonobstructive. […] The latter, termed ischemia and no obstructive coronary arteries (INOCA), has a high prevalence that occurs mostly in middle-aged women; however, effective treatment remains elusive.

• #26 Spotlight Series | Microvascular Dysfunction Treatment Options For Coronary Microvascular Dysfunction

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/11/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Treatment-Options-For-Coronary-Microvascular-Dysfunction

  Studies evaluating sildenafil, quinapril, estrogen and transcutaneous electrical nerve stimulation application demonstrated benefits in their respective endpoints. Very limited to no benefit was observed with L-arginine, doxazosin, pravastatin and diltiazem. […] Our systematic review highlights that there are few data to support consensus documents or clinical practice guideline-recommended therapies for CMD. Some pertinent highlights are summarized here that we believe may be useful for future large, randomized, controlled trials. […] Some of these treatments are listed in the Table. Briefly, statins, ACE inhibitors and ARBs have shown considerable promise. These smaller trials are supported by several recent very large registries reporting that patients with nonobstructive CAD receiving statins have significantly better outcomes compared with those who were not receiving statins.

• #27 Spotlight Series | Microvascular Dysfunction Treatment Options For Coronary Microvascular Dysfunction

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/11/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Treatment-Options-For-Coronary-Microvascular-Dysfunction

  Drugs influencing the RAAS (ACE inhibitors or ARBs) have a strong rationale and have shown promise. But adding aldosterone blockade to an ACE inhibitor or ARB did not result in additional improvement. Late sodium channel blockade and estrogens also have some compelling data. […] Additionally, many nonpharmacologic studies have suggested promise. Most attractive are those using exercise. […] Although some treatments have been associated with promising results, no specific treatment has been sufficiently well documented to be recommended in any patient group or subgroup with CMD. Clearly, there is a key unmet need for larger, well-designed, clinical trials addressing adverse outcomes prevention in this population.

• #28 Coronary Microvascular Disease | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd

  Relieving pain is one of the main goals of treating coronary MVD. Treatments can also control risk factors and other symptoms. […] Treatments may include: […] Cholesterol medication to improve cholesterol levels […] Blood pressure medications to lower high blood pressure and decrease the heart’s workload […] Antiplatelet medication to help prevent blood clots […] Beta blockers, calcium channel blockers or nitroglycerin to relax blood vessels […] Nitroglycerin to treat chest pain […] Surgeries such as coronary artery bypass grafting or percutaneous coronary intervention […] Enhanced external counterpulsation to apply pressure to your lower legs to improve blood flow to the heart.

• #29 The big problem of small vessel disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11133652/

  In this issue of American Heart Journal Plus: Cardiology Research and Practice small vessel disease, a ubiquitous pathologic process, is discussed from a variety of different perspectives. […] While small vessel disease is associated with significant morbidity and mortality, there is no specific effective treatment due, at least in part, to insufficient understanding of the mechanisms involved. […] As with small vessel disease of the brain, kidney and heart, inflammation and ischemia are key pathologic processes, and the mainstay of systemic treatment is to control blood pressure and blood sugar levels. […] Treatment for cerebral small vessel disease is focused on aggressive management of risk factors, primarily, smoking cessation and lowering of blood pressure and cholesterol. […] However, evidence suggests that abnormalities of the microvasculature play an important role in this disease.

• #30 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology

  https://svn.bmj.com/content/1/3/83

  Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Single antiplatelet (for acute lacunar ischaemic stroke) and management of traditional risk factors still remain the most important therapeutic and preventive approach, due to limited understanding of pathophysiology in CSVD. […] Increasing evidence suggests that new studies should consider drugs that target endothelium and blood-brain barrier to prevent and treat CSVD. […] Management of traditional risk factors is still the main approach for treating or preventing CSVD, despite the fact that most of these treatments have not yet shown ideal effects on long-term outcome. […] Studies of treatment specifically targeting lacunar stroke are limited. […] Prevention and treatment of CSVD in the future should consider targeting the BBB, brain endothelium and microvascular function.

• #31 Repurposing cheap and common drugs to treat cerebral small

  https://www.ukdri.ac.uk/news-and-events/repurposing-cheap-and-common-drugs-to-treat-cerebral-small-vessel-disease

  Over two sequential trials, Lacunar Intervention Trial-1 and 2 (LACI-1, -2), the researchers not only established that people could safely take both drugs for a whole year, but also found clues suggesting positive effects, such as preventing further strokes, and maintaining cognitive ability or physical function. […] Earlier this summer, the National Institute for Health and Care Research (NIHR) granted funding for the LACI-3 Trial, the largest phase of Joannas small vessel disease research so far. […] This will be the first large trial in small vessel disease which will have a primary cognitive outcome, and the first trial in vascular cognitive impairment at phase three. […] According to Joanna, the LACI trials have sparked international interest because they open the door to other drugs being repurposed in the same way, or even to similar trials for people with other conditions due to small vessel disease.

• #32 Repurposing cheap and common drugs to treat cerebral small

  https://www.ukdri.ac.uk/news-and-events/repurposing-cheap-and-common-drugs-to-treat-cerebral-small-vessel-disease

  Another positive of this approach is accessibility of this treatment, if LACI-3 and all the regulatory processes are successful. Isosorbide mononitrate and cilostazol are two drugs that have been off-patent for some time, meaning they are inexpensive. […] For Joanna, the most important thing about her work is that it is demonstrating that small vessel disease, the main cause of vascular dementia and vascular cognitive impairment, is treatable. […] Its a good time to be working in the stroke and dementia fields. Im very pleased to see that we may be able to do something to help people with small vessel disease, vascular cognitive impairment and vascular dementia. If this works out, it will be fantastic, she concludes.

• #33 Coronary Microvascular Disease (Small Vessel Disease): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21052-microvascular-coronary-disease

  What treatments are available for patients with microvascular coronary disease? Treatment often involves medications to help blood vessels work more effectively and lower the risk of complications. Care may include: Angiotensin-converting-enzyme (ACE) inhibitors. Anticoagulants. Aspirin. Beta-blockers. Calcium channel blockers. Diuretics. Statins. […] With successful treatment, many people feel better and resume daily activities. You may need ongoing follow-up care to make sure therapies are working as they should. […] Medications and lifestyle changes help many people get symptom relief and avoid complications.

• #34 Microvascular Disease: Causes, Symptoms & Treatment | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/microvascular-disease

  For some patients, medication may be necessary alongside lifestyle changes and risk factor management. Common medications used to treat CMD include statins, angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers and nitrate therapy. Individualized treatment regimens are key to our approach. […] The CMD Program at TGH is at the forefront of cardiac disease research and has access to industry- and physician-sponsored clinical trials, such as the Discover INOCA study. These efforts contribute to defining diagnostic and treatment approaches to CMD management for future patients.

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