Introduction Of Ischemic Heart Disease
Ischemic heart disease describes a group of clinical syndrome that develops when there is an imbalance between supply of blood to the heart muscle and demand. Ischemic heart disease, also known as coronary heart disease, is common in the United States and is a leading cause of death worldwide. It occurs due to accumulation of cholesterol particles on the walls of the arteries that supply blood to the heart. Eventually, these deposits narrow the arteries and block the flow of blood. This reduction in blood flow decrease the amount of oxygen supplied to the heart muscle . Coronary heart disease (CHD) remains a leading cause of mortality and morbidity all over the world. As stated by World Health Organization (WHO) in 2005, 17.5 million (30%) of the 58 million deaths take place globally due to cardiovascular disease. While the occurrence and mortality due to CHD is decreasing in the developed nations. On the other hand, the prevalence of CHD and cardiovascular mortality in India and other south Asian countries has been increasing rapidly over the past two decades. Current estimates from epidemiologic studies from different parts of the country indicate an incidence of CHD to be between 7% and 13% in urban while 2% and 7% in rural populations .
Management of Ischemic Heart Disease
Treatment for coronary artery disease or Ischemic heart disease usually involves lifestyle changes and, if required, drugs and certain medical procedures .
Life Style Changes
- Exercise regularly.
- Eat healthy foods.
- Lose excess weight.
- Reduce stress.
- Quit smoking.
Drugs used to treat Ischemic Heart Disease
Various drugs are commonly used to treat Ischemic heart disease including:
- Cholesterol-modifying medications.
- Beta blockers.
- Calcium channel blockers.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).
Procedures to restore and improve blood flow
- Angioplasty and stent placement (percutaneous coronary revascularization)
- Coronary artery bypass surgery
Usage of stem cells on Ischemic heart disease
Several studies demonstrate the role of mesenchymal stem cells (MSC) for the treatment of Ischemic heart diseases. MSC can be safely derived from adult bone marrow and proliferate by in vitro culturing which can be safely administered without the need for immunosuppressant agents, and they are less susceptible to genetic abnormalities and malignant transformation throughout the time of multiple passages in vitro . Various animal studies models of myocardial infarction have indicated the potential of transplanted MSC to engraft and differentiate into vascular cells and cardiomyocytes . MSC have been used in humans for approximately 10 years to regenerate or repair injured heart, either directly or indirectly (through paracrine effects). Many clinical trials demonstrated that intracoronary administration of autologous bone marrow-derived MSC can improve left ventricular function in patients with myocardial infarction (MI) . Additionally, safety trials and clinical feasibility for bone marrow allogeneic mesenchymal cells also have been published in patients with myocardial infarction . According to the study conducted by Chen et al. significant difference was found in the improvement of left ventricular ejection fraction (LVEF) in the MSC group in comparison to placebo group after injecting 48–60 X 109 MSCs into the infarct related coronary artery . Similarly, Hare et al. published a dose escalation study of allogenic MSCs (0.5×106/kg, 1.6×106/kg, and 5 x 106/kg) in patients post-percutaneous coronary intervention (PCI) for acute MI. Remarkably, increase in LVEF at 3, 6, and 12 months was found in the MSC group compared to the placebo group . In conclusion, number of clinical studies demonstrated that the mesenchymal stem cell can be significant in improving the heart function in the treatment of myocardial infarction. Currently, there are over 25 trials of MSC delivery for cardiac regeneration registered with clinicaltrials.gov, including for acute MI and ischemic cardiomyopathy.