If you’re 50 or older, you’re probably paying more attention to your heart health. Your doctor has likely already brought up the big things to watch for, like atherosclerosis and coronary artery disease. But they may not have told you about small things that become big — conditions like microvascular disease (also called MVD or small vessel disease).
You might have heard that MVD is just part of getting older. But in many cases, it’s a precursor to heart disease.
Here’s everything you should know about how to catch it and control it.
A brief overview of microvascular disease
Microvascular disease refers to damage in your microvessels, which are tiny blood vessels known as arterioles, capillaries, and venules. Most are no bigger than a few human hairs, although some are capable of storing up to 75% of your total blood volume.
Microvascular disease can occur in many different contexts:
- Around the brain
- In the kidneys
- Inside the retinas
- Around the heart (where we’re predominantly focusing here)
When microvessels become damaged by injury or inflammation, they can’t properly dilate or contract, which may lead to spasming. But because these vessels are so tiny, you probably won’t know that something’s amiss. You’ll need a large number of improperly functioning microvessels before identifying a problem — and by then, the damage is already done.
This is why small vessel disease was once referred to as ‘cardiac syndrome X’: doctors couldn’t determine why people felt chest pain without the obvious signs of narrowed arteries. But with the advent of technology, we can look closer at ultra-small vessels. Today, researchers believe as many of 50% of people who request imaging for chest pain don’t have any evidence of narrowed arteries (just microvascular dysfunction).
This, of course, can lead to a false sense of security. These are ‘just’ tiny vessels, after all. Plus, microvascular disease affects 5% of people above the age of 50 and nearly 100% of people over 90. If so many older people have it, microvascular disease must be ‘normal’ — right?
It’s true that some microvascular dysfunction is expected as you age. But an early appearance could be a warning sign of future health concerns.
In fact, studies show early-onset microvascular disease may lead to more serious heart conditions and possibly early death.
Why microvascular disease is anything but ‘normal’
Researchers once believed that microvascular disease was benign. Since it’s so common among older people, many inferred it was simply a side effect of aging. It was also not assumed to have any direct impact on ‘real’ heart disease, since the vessels are small and don’t necessarily experience dangerous blockages.
But we now know that this is only partially true.
We see the main causes of small vessel disease are tied to the same risk factors as ‘big’ heart disease: high blood pressure, obesity, diabetes, and even autoimmune conditions. We also know that spasms from damaged microvasculature may “be responsible for ischaemia with [an] increased level of cardiac enzymes” (i.e., a contributor to stroke and coronary heart disease).
The numbers speak for themselves:
- Microvascular ischemic disease is associated with up to 45% of dementia cases and causes up to 25% of strokes.
- Coronary microvascular disorders may worsen the onset of other heart-related diseases.
- Almost one in eight people with microvascular angina (people who have chest pain without arterial blockage) will have an adverse cardiac event each year.
Other effects of microvascular dysfunction are often misattributed to the ‘normal’ cause of aging. Symptoms like brain fog, fatigue, and poor vision are common among older populations, so some doctors might tell you that you’re getting older instead of making the connection to poor microvascular health.
As a heart surgeon, let me be clear: early-onset microvascular disease should be considered anything but normal. It’s a sign of poor metabolic health and a precursor to more serious heart disease.
And if you wait too long to address it, you might be tempting fate with a heart attack.
Are you at risk for microvascular disease?
The question is knowing whether or not you’re at risk.
You may want to get tested for microvascular disease if:
- You feel the symptoms of angina, which is a squeezing chest pressure or pain. It may also indicate you’re in a higher risk bracket for coronary artery disease (43.9% likelihood compared to 31.5% for those without angina symptoms).
- You feel tired or weak completing everyday tasks. This is somewhat different from atherosclerosis, in which you typically feel symptoms while engaging in exercise.
- You’re struggling with insomnia. This is one of the most surprising first signs of a weak heart.
- You’re suffering from metabolic syndrome. This includes excessive belly fat, poor blood sugar control, high blood pressure, and an abnormal triglyceride-to-HDL ratio. You’re welcome to take my free metabolic health quiz to check for metabolic syndrome.
- You’re at or above the age of 50. The older you get, the more capillaries you lose, and the lower blood flow becomes. Keep in mind older women are more likely to experience microvascular disease, especially during menopause.
You have a few different options for testing microvascular disease. Cardiac catheterization is one of the most common options, although keep in mind it’s fairly invasive. Less invasive techniques include PET scans and cardiac MRIs, although you’ll likely need to be referred by a physician.
How to reverse microvascular ischemic disease
Just because small vessel disease is common doesn’t mean it’s not serious. The good news is that progression can be halted (and even reversed) if caught in the early stages.
The easiest way to do this is to restore your metabolic health. Remember: one of the same mechanisms that leads to atherosclerosis (inflammation) can negatively affect microvasculature around the heart, kidneys, and brain. This means avoiding activities that contribute to inflammation, such as:
- Drinking and smoking
- Eating highly processed foods with added sugar
- Sleeping less than six hours per night
- Not exercising daily
Instead, you should focus on eating whole, real foods, moving at least 30 minutes per day, and avoiding activities that contribute to poor metabolic health.
Of course, I don’t expect you to do this all at once. I also want to make it easy to start reclaiming your metabolic health today.
You can start by learning about the seven principles of metabolic health to get a better idea of the road ahead.
