DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20210848

Modifiable risk factors of vasospastic angina: a systematic literature review

Abdulmajeed F. Albalawi, Hamoud T. Alotaibi, Razan K. Alharbi, Abdulrahman A. Alghamdi, Ali A. Alzahrani, Jwael A. Alhamoud, Saleem A. Alzahrani, Noof Y. Safhy, Reem K. Aqeeli, Sami M. Hamdhi, Eman N. Albarrak, Jawza S. Alshammari, Waleed K. Alshehri, Muhammad Hashim Ghouri

Abstract


Vasospastic angina is caused by transient coronary spasms unrelated to exertion, which may even occur at rest (classically at night) and promptly responds to short acting nitrates. It is thought to be caused by inherent generalised hyper reactivity of the smooth muscle cells of epicardial vessels to various stimuli. Being comparatively less studied, the risk factors for VSA vary considerably from obstructive or atherosclerotic cardiac disease. However, coronary vasospasm can occur in non stenosed arteries, atherosclerotic arteries as well as sub critically stenosed arteries which can result in significant overlap between the risk factors and underlying pathophysiology. 1-14% of AMI can be caused by non-obstructive, or ‘functional’ coronary artery disorders like vasospastic angina but VSA continues to be underdiagnosed and less well understood than obstructive coronary artery disorders. This prompted us to study the existing literature for modifiable risk factors of coronary artery vasospasm so that an emphasis can be made on proper lifestyle modifications and avoidance of vasospastic agents in susceptible individuals. Smoking proved to be the most important risk factor whereas recreational drugs and drugs used for treatment of certain medical disorders have also been shown to associate with coronary vasospasm. Medical personnel, therefore, need to be more vigilant in history taking as well as investigating cardiac chest pain in which traditional investigations end up being normal so that an early diagnosis of vasospastic angina can be made and appropriate steps taken to improve the quality of life of patients.


Keywords


Coronary artery spasm, Vasospastic angina, Variant angina, Prinzmetal angina

Full Text:

PDF

References


Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.

JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008)– digest version. Circulation Journal. 2010;74(8):1745-62.

Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U et al. Coronary Vasomotion Disorders International Study Group (COVADIS). International standardization of diagnostic criteria for vasospastic angina. European heart journal. 2017;38(33):2565-8.

Kaski JC, Maseri A, Vejar M, Crea F, Hackett D, Halson P. Spontaneous coronary artery spasm in variant angina is caused by a local hyperreactivity to a generalized constrictor stimulus. Journal of the American College of Cardiology. 1989;14(6):1456-63.

Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S et al. Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina. Circulation. 1986;74(6):1255-65.

Kugiyama K, Yasue H, Okumura K, Ogawa H, Fujimoto K, Nakao K et al. Nitric oxide activity is deficient in spasm arteries of patients with coronary spastic angina. Circulation. 1996;94(3):266-72.

Kugiyama K, Ohgushi M, Motoyama T, Sugiyama S, Ogawa H, Yoshimura M et al. Nitric oxide-mediated flow-dependent dilation is impaired in coronary arteries in patients with coronary spastic angina. Journal of the American College of Cardiology. 1997;30(4):920-6.

Come PC. Coronary arterial spasm. J Fam Pract. 1982;14(1):119-9.

Beijk MA, Vlastra WV, Delewi R. Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. Netherlands Heart Journal: Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2019;27(5):237-45.

Peretz DI. Variant angina pectoris of Prinzmetal. Canadian Medical Association Journal. 1961;85(20):1101.

Rasheed, A., & Kaleem, M. (2017). Association of Hyperuricemia with Coronary Artery Disease in Gulab Devi Chest Hospital. Int J Front Sci. 2017;1(2):17-25.

Scholl JM, Benacerraf A, Ducimetiere P, Chabas D, Brau J, Chapelle J et al. Comparison of risk factors in vasospastic angina without significant fixed coronary narrowing to significant fixed coronary narrowing and no vasospastic angina. The American journal of cardiology. 1986;57(4):199-202.

Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J et al. Long-term prognosis for patients with variant angina and influential factors. Circulation. 1988;78(1):1-9.

Myerburg RJ, Kessler KM, Mallon SM, Cox MM, Demarchena E, Interian Jr A et al. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. New England Journal of Medicine. 1992;326(22):1451-5.

MacAlpin RN. Cardiac arrest and sudden unexpected death in variant angina: complications of coronary spasm that can occur in the absence of severe organic coronary stenosis. American heart journal. 1993;125(4):1011-7.

Shafi, Madiha, Mehmood, Humaira, Afsar, Saeed, Bokhari, Zoaib Raza, & Abbasi, Saleem. (2019). Cardiovascular Disease and Its Risk Factors Among Employees of Sindh Government; A Cross Sectional Survey from Karachi, Pakistan. Int J Front Sci. 2019;3(2):84–90.

Aboukhoudir F, Aboukhoudir I, Pansieri M, Rekik S. Coronary spasm associated with dobutamine in patients with false positive stress echocardiograms: prevalence and predictors. In: Annals of Cardiology and Angiology. 2015;64(5):313-17.

Ashikaga T, Nishizaki M, Fujii H, Niki S, Maeda S, Yamawake N, et al. Examination of the microcirculation damage in smokers versus nonsmokers with vasospastic angina pectoris. The American journal of cardiology. 2007;100(6):962-4.

Caralis DG, Deligonul U, Kern MJ, Cohen JD. Smoking is a risk factor for coronary spasm in young women. Circulation. 1992;85(3):905-9.

Davies O, Ajayeoba O, Kurian D. Coronary artery spasm: An often overlooked diagnosis. Nigerian medical journal: journal of the Nigeria Medical Association. 2014;55(4):356.

Itoh T, Mizuno Y, Harada E, Yoshimura M, Ogawa H, Yasue H. Coronary spasm is associated with chronic low-grade inflammation. Circulation Journal. 2007;71(7):1074-8.

Klein RM, Niehues R, Heintzen MP, Leschke M, Strauer BE. Acute myocardial ischemia in spontaneous coronary artery spasms. DMW-German Medical Weekly. 1995;120(44):1495-501.

Maouad J, Fernandez F, Hebert JL, Zamani K, Barrillon A, Gay J. Cigarette smoking during coronary angiography: diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms. Catheterization and cardiovascular diagnosis. 1986;12(6):366-75.

Morita S, Mizuno Y, Harada E, Nakagawa H, Morikawa Y, Saito Y et al. Differences and interactions between risk factors for coronary spasm and atherosclerosis-smoking, aging, inflammation, and blood pressure. Internal Medicine. 2014;53(23):2663-70.

Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation. 1993;87(1):76-9.

Menyar AA. Drug-induced myocardial infarction secondary to coronary artery spasm in teenagers and young adults. Journal of postgraduate medicine. 2006;52(1):51.

Askandar S, Flatt D, Rosu D, Khouzam RN. Postpartum Coronary Arterial Spasm. The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society. 2017;169(4):101-5.

Chang KS, Wang KY, Yao YW, Huang JL, Lee WL, Ho HY et al. Catheter-induced coronary spasm--a view of mechanical factors and experience with selective left coronary arteriography. Zhonghua yi xue za zhi= Chinese medical journal; Free China ed. 2000;63(2):107-12.

Culnan DM, Sood R. Coronary vasospasm after burn injury: first described case series of a lethal lesion. Journal of Burn Care & Research. 2018;39(6):1053-7.

Forman MB, Blass M, Jackson EK. Variant angina in the setting of food-borne botulism. Clinical infectious diseases. 2011;53(12):1300-1.

Hori R, Suzuki T, Hayano J. Association between type a behavior pattern and coronary artery spasm in japanese patients. International journal of behavioral medicine. 1996;3(3):221-32.

Hung MJ, Hung MY, Cheng CW, Yang NI, Cherng WJ. Clinical characteristics of patients with exercise-induced ST-segment elevation without prior myocardial infarction. Circulation Journal. 2006;70(3):254-61.

Kimura H, Ogawa S, Koga Y, Mishima Y, Ushijima K. A case of ventricular tachycardia that was probably caused by coronary artery spasm induced by pericardial manipulation. Masui. The Japanese journal of anesthesiology. 2014;63(11):1272-5.

Numata Y, Ogata Y, Oike Y, Matsumura T, Simada K. A psychobehavioral factor, alexithymia, is related to coronary spasm. Japanese circulation journal. 1998;62(6):409-13.

Previtali M, Ardissino D, Barberis P, Panciroli C, Chimienti M, Salerno JA. Hyperventilation and ergonovine tests in Prinzmetal's variant angina pectoris in men. Am J Cardiol. 1989;63(1):17-20.

Satake K, Lee JD, Shimizu H, Ueda T, Nakamura T. Relation between severity of magnesium deficiency and frequency of anginal attacks in men with variant angina. Journal of the American College of Cardiology. 1996;28(4):897-902.

Wang L, Yang J, Zheng J, Gu X. Acute myocardial infarction in pregnancy: spasm caused by hyperthyroidism?. Journal of International Medical Research. 2019;47(5):2269-73.

Burt BA. Definitions of risk. Journal of dental education. 2001;65(10):1007-8.

Beijk MA, Vlastra WV, Delewi R, van de Hoef TP, Boekholdt SM et al. Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. Netherlands Heart Journal. 2019;27(5):237-45.

Koneru J, Cholankeril M, Patel K, Alattar F, Alqaqa A, Virk H et al. Postpartum coronary vasospasm with literature review. case reports in cardiology. 2014;2014.

Williams MJ, Restieaux NJ, Low CJ. Myocardial infarction in young people with normal coronary arteries. Heart. 1998;79(2):191-4.

Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001 Jun 12;103(23):2805-9.

Grześk G, Polak G, Grąbczewska Z, Kubica J. Myocardial infarction with normal coronary arteriogram: the role of ephedrine-like alkaloids. Medical Science Monitor. 2004;10(4):CS15-21.

Chen C, Biller J, Willing SJ, Lopez AM. Ischemic stroke after using over the counter products containing ephedra. Journal of the neurological sciences. 2004;217(1):55-60.

Rezkalla SH, Mesa J, Sharma P, Kloner RA. Myocardial infarction temporally related to ephedra--a possible role for the coronary microcirculation. WMJ: official publication of the State Medical Society of Wisconsin. 2002;101(7):64-6.

Mori E, Ikeda H, Ueno T, Kai H, Haramaki N, Hashing T et al. Vasospastic angina induced by nonsteroidal anti‐inflammatory drugs. Clinical cardiology. 1997;20(7):656-8.

Fernández JS, Lado MP, González NV, Rico ML, Pardavila EA, Beiras AC. Acute myocardial infarction after anaphylactic reaction to amoxicillin. Revista espanola de cardiologia. 1999;52(8):622-4.

Ziccardi MR, Hatcher JD. Prinzmetal Angina. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK430776/. Last accessed on 17th December, 2019.

DeFilippis EM, Bajaj NS, Singh A, Malloy R, Givertz MM, Blankstein R et al. Marijuana Use in Patients With Cardiovascular Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Jan 28;75(3):320-32.