Understanding the Complex Causes of Ischemic Cardiomyopathy and Heart Disease

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• Cardiomyopathy Patient Age Groups
• Known Coronary Disease Risk Factors
• Unexplained Heart Disease Cases
• Vasa Vasorum Theory of CAD
• Genetic Influences on Heart Disease
• Future Heart Disease Research
• Full Transcript

Cardiomyopathy Patient Age Groups

Dr. Pascal Leprince, MD, observes significant overlap in the age of patients presenting with different cardiomyopathy types. He notes that patients requiring heart transplantation for ischemic cardiomyopathy are often surprisingly young. Dr. Pascal Leprince, MD, explains that while idiopathic cardiomyopathy typically appears in patients aged 50 to 60, severe ischemic cardiomyopathy can strike even earlier. He states that it is not uncommon to see patients with bad coronary artery disease in their 40s and 50s.

Known Coronary Disease Risk Factors

Dr. Pascal Leprince, MD, confirms that medicine has identified several major risk factors for coronary artery disease and atheroma formation. These well-established risks include high cholesterol, a sedentary lifestyle, male gender, advancing age, hypertension, and tobacco use. Dr. Leprince strongly emphasizes the critical importance of controlling these factors through medication and lifestyle changes. He references numerous clinical trials that confirm lowering cholesterol and blood pressure significantly reduces cardiovascular risk.

Unexplained Heart Disease Cases

A perplexing phenomenon in cardiology is the patient who develops severe coronary artery disease despite an apparently perfect lifestyle. Dr. Pascal Leprince, MD, describes patients who never smoked, had normal cholesterol levels, and were devoid of diabetes, yet still presented with bad coronary disease. Conversely, he points out that some individuals who abuse their health with smoking and poor diets never develop heart problems. This paradox suggests that known risk factors do not tell the complete story of coronary artery disease pathogenesis.

Vasa Vasorum Theory of CAD

Dr. Pascal Leprince, MD, highlights innovative research into alternative explanations for coronary artery disease. He specifically mentions the work of Dr. Axel Haverich, a chief cardiac surgeon in Hannover, who is exploring a different concept. This theory focuses on the role of the vasa vasorum, the small blood vessels that supply the walls of larger arteries like the coronaries. Dr. Leprince suggests that the health and vascularization of the coronary artery wall itself may be a critical differentiating factor in disease development, a area requiring much more research.

Genetic Influences on Heart Disease

Family history remains a crucial piece of the diagnostic puzzle for unexplained coronary artery disease. Dr. Pascal Leprince, MD, fully agrees that a history of early coronary disease across multiple generations strongly points to a genetic cause. However, he also notes that many patients present with no known family history of the condition, further complicating the picture. Dr. Leprince uses a powerful analogy, stating that current medical science only understands the "upper part of the iceberg" when it comes to the root causes of heart disease.

Future Heart Disease Research

The quest to understand the deeper biological mechanisms of ischemic cardiomyopathy is a major frontier in medicine. Dr. Pascal Leprince, MD, expresses a hopeful outlook for the future of cardiovascular research. He believes that over the next 50 to 100 years, science will uncover the mysteries behind why low-risk patients develop severe coronary artery disease. This advancement will require a detailed investigation into the "deeper part of the iceberg," moving beyond traditional risk factors to explore genetics, cellular biology, and vascular physiology.

Full Transcript

Dr. Anton Titov, MD: Ischemic cardiomyopathy is probably seen more often in elderly patients, compared with idiopathic cardiomyopathy or hypertrophic cardiomyopathy. Or do all these groups completely overlap?

Dr. Pascal Leprince, MD: I think cardiomyopathy groups overlap. Patients with ischemic cardiomyopathy that we have here for heart transplantation are pretty young. I think there is an overlap between ischemic, idiopathic, and hypertrophic cardiomyopathy.

We see patients with idiopathic cardiomyopathy around the age of 50 to 60. Some of the ischemic cardiomyopathy patients are even younger, 40 to 50 years old. They have bad coronary artery disease. Medical second opinion is important. Bad coronary disease in 40 to 50-year-old patients.

Dr. Anton Titov, MD: Do you think there is a significant genetic influence on ischemic cardiomyopathy? Or do you think it is the sedentary lifestyle and never controlling cholesterol levels when they are in their 30s and 40s? Then they have an "oops" moment when they are 50 years old. Then it is too late. The arteries are already laden with cholesterol plaques.

Dr. Pascal Leprince, MD: I think it is not easy to answer this question. Because we think that we know all risk factors for coronary disease, for atheroma: it is high cholesterol, sedentary lifestyle, male gender, aging, hypertension, tobacco. All those risks for coronary artery disease are known.

What amazes me is that we see some patients coming to the clinic. They never smoked, they have normal cholesterol; they do not have diabetes. They are maybe too strict with their lifestyle. They do have bad coronary artery disease.

On the other hand, we know that some patients abuse their health. They smoke, they eat a high cholesterol diet, they don't take good care of themselves. But they don't have coronary artery disease.

So, on the one hand, I think that some patients get coronary artery disease because they have heart disease risk factors. But for me, this is not the only story of how patients get coronary artery disease.

Some doctors do work on unknown risks for heart disease. Dr. Axel Haverich is a Chief cardiac surgeon in Hannover. He is working on a different concept of coronary artery disease. Maybe it would be interesting for you to interview Dr. Axel Haverich. He's a great man.

The vascularization of the wall of the coronary artery with the vasa vasorum can make the difference for coronary artery disease. Vasa vasorum are small blood vessels that provide blood to larger blood vessels. I will not go through more than that because I don't have enough knowledge about that.

But I'm pretty sure there are other explanations to coronary artery disease apart from lifestyle. Of course, the risk factors are very important. Sometimes you have a high cholesterol; it is very important to lower the cholesterol. There are many clinical trials confirming that.

I'm not saying that we should not look very efficiently for risk factors found in those clinical trials. It is very important you have a low blood pressure. Patient has to control blood pressure, to control cholesterol, to control diabetes. Physical activity every day is very important. To lower all these risk factors is very important.

But, again, this might be not the whole story with coronary artery disease. This is why we sometimes see patients with no risk factors but who have coronary artery disease.

Dr. Anton Titov, MD: I'm sure in those situations you probably look in their family history. Do they have early coronary disease running across generations? This would point out to the genetic cause.

Dr. Pascal Leprince, MD: Yes, yes, I agree. We know that heredity is a very important risk factor for coronary artery disease. But some patients with coronary artery disease don't have any relatives with known coronary disease.

We still understand only the upper part of the iceberg, but not the deeper part of the iceberg. It is very important to look at that deeper part in detail. Hopefully in the next 50 or 100 years we will know better about causes of coronary artery disease in patients with low risk factors.