Angina without obstructive coronary artery disease (part 3). Modern treatment strategies

S. Solovey

T he main cause of angina in patients without obstructive coronary artery (CA) disease is vasomotor dysfunction, including various pathophysiological endotypes: macro- or microvascular vasospasm, reduced microvascular vasodilation or increased resistance, as well as their combinations. Such patients not only have persistent angina symptoms, leading to frequent hospitalizations and repeated diagnostic tests for obstructive coronary heart disease (CHD), but also an increased risk of adverse cardiovascular events. In such cases, standard antianginal therapy turns out to be less effective, and the development of new pharmacological agents specific for this variant of CHD still remains an unsatisfied need. At the same time, it has been shown that compliance with the treatment protocol corresponding
to a specific disease endotype improves symptom control and quality of life.
Treatment of patients includes lifestyle modification measures with control
of cardiovascular risk factors, and antianginal therapy, the targeting of which requires accurate, in most cases invasive, diagnosis of pathophysiological endotype. An important component of the treatment process is a non-drug effect, especially in patients with refractory angina pectoris. The article discusses various treatment options (including experimental) and their rationale in patients with angina pectoris without obstructive lesions of the СА.

keywords: non-obstructive lesion, microvascular dysfunction, epicardial vasospasm, microvascular angina, vasospastic angina.

for references: S.P. Solovey. Angina without obstructive coronary artery disease (Part 3). Modern treatment strategies.

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