Treatment

Treatment of Coronary Microvascular Dysfunction

The treatment methods for microvascular angina have not yet been firmly established. Typically, management begins with the improvement of coronary risk factors and lifestyle modifications. If these measures are insufficient, β-blockers and calcium channel blockers (CCBs) are recommended as first-line medications. In many countries, β-blockers are often the central focus of treatment; however, in Japan, CCBs are more frequently used as the first-choice medication compared to other countries. This may be partly because cases of microvascular spasm are considered more common in Japan and other Asian populations than abroad. Additionally, CCBs are highly effective against coronary artery spasm on the heart surface, which is often observed in Japanese and Asian individuals. Therefore, when microvascular spasm is suspected to coexist, CCBs are recommended as the first-line therapy.

Even in cases where chest pain cannot be controlled with these medications, the efficacy of ACE inhibitors and statins has also been reported. These drugs are believed to contribute to the improvement of coronary microcirculatory disorders through their antioxidant, anti-inflammatory, and endothelial function-enhancing effects.

Moving forward, our research group aims to disseminate optimal treatment strategies for coronary microvascular dysfunction in Japan.