[Therapy of microvascular angina]

Area of Science:

• Cardiology
• Vascular Biology
• Pharmacology

Context:

• Microvascular angina, characterized by anginal pain from myocardial ischemia due to small coronary artery dysfunction, lacks effective treatments.
• Current therapeutic strategies are largely empirical, with limited understanding of the underlying pathophysiologic mechanisms and disease heterogeneity.
• Traditional anti-ischemic therapies, including sublingual nitrates, often show limited efficacy in improving symptoms and exercise tolerance.

Purpose:

• To review the current state of microvascular angina treatment.
• To highlight the limitations imposed by poor knowledge of pathophysiologic mechanisms and disease heterogeneity.
• To discuss potential alternative therapeutic approaches and the need for further evaluation.

Summary:

• Treatment for microvascular angina remains empirical and frequently ineffective, primarily due to insufficient knowledge of its pathophysiology and heterogeneous nature.
• Standard anti-ischemic therapies often fail, as evidenced by persistent angina and reduced exercise capacity even with nitrate administration.
• While beta-blockers and calcium-channel blockers offer symptomatic relief in some patients, the clinical utility of alternative treatments like xanthine derivatives, ACE-inhibitors, and others requires more rigorous investigation.

Impact:

• Identifies critical knowledge gaps in microvascular angina pathophysiology.
• Underscores the limitations of current treatment paradigms.
• Emphasizes the urgent need for well-designed clinical trials to validate novel therapeutic strategies for microvascular angina.