Author + information
- Chayakrit Krittanawong, MD∗ (, )
- Alan Rozanski, MD and
- Angela Palazzo, MD
- ↵∗Division of Cardiology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, Suite 3A-09, New York, New York 10019
Saw et al. (1) have reported a high frequency of recurrent events following spontaneous coronary artery dissection (SCAD), including recurrent SCAD. As in prior experiences, SCAD occurred predominantly in women, and many of these women were pre-menopausal. To date, however, optimal means for preventing recurrent events in patients with SCAD remains unclear. Thus, it is notable that Saw et al. (1) also found that hypertension independently predicted recurrent SCAD and that β-blocker treatment reduced the incidence of recurrent SCAD in a multivariate model (1). β-Blockers are presumably beneficial in reducing coronary arterial wall stress in patients with SCAD.
In addition, participation in cardiac rehabilitation (CR) represents another potential means that should be strongly explored to reduce risk in patients with SCAD. CR is associated with a reduction in blood pressure, improvement in sympathovagal balance, and decreased risk of recurrent atherosclerotic myocardial infarction (MI) (2). Several studies, as well as animal models, have also suggested that exercise training during CR may augment the effects of β-blockers in both MI patients and healthy volunteers (2–4). Moreover, Malfatto et al. (2) have shown that post-MI patients who used β-blockers and who underwent CR had a better autonomic profile both in the short term and the long term compared with patients who underwent CR without β-blockers. Thus, a combination therapy of β-blockers and CR could potentially regulate sympathetic activation in a more efficient manner than can β-blockers alone.
Saw et al. (1) also noted that precipitating emotional and physical stressors were common among their SCAD cohort. To this end, we have recently reported that CR can also improve the physical, psychological, and emotional status of patients with SCAD (5).
Interestingly, according to the Mayo Clinic registry, several health care providers hesitate to recommend CR because of limited data (5). However, CR has been shown to be safe in patients with SCAD and may attenuate the risk of recurrent SCAD through several potential mechanisms. Thus, until clinical trials can produce meaningful data, CR should be routinely considered in combination with β-blockers in patients with SCAD to prevent recurrent SCAD.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
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