Variant Angina: Why do you Ignore Spasm of Coronary Arteries?

Many authors reported on variant (form of) angina (Prinzmetal’s Variant Angina, vasospastic angina) till 1990s on the various aspects of this disease. However, in this century, articles on this very important disease have become very few. One reason of this apparent ignorance of vasospastic angina may be caused by a report by Cianflone et al. in 2000 1, in which they studied only 34 patients and concluded that vasospasm is much less in Caucasian peoples. A scientific research, especially in clinical medicine, at least more than several hundred patients must be studied for some conclusion. Thus, I feel, their result is very questionable and responsibility of American Heart Association to have adopted such poor report is very large to practical medicine and all natural sciences. Why cardiologists nowadays have no concern to variant angina? As I describe below, diagnosis and treatment of patients with vasospasm are very important. In reality, it is sure that in some subjects it is very difficult to prove or deny the presence of coronary vasospasm. However, as coronary vasospasm, even in the absence of significant coronary narrowings, triggers acute myocardial infarction and fatal arrhythmias, we must be very careful to deny vasospasm. One of important problem is in medical treatment. Drugs to subjects with vasospasm are different from those patients without vasospasm (i,e. propranolol is effective to subjects with effort angina but very hazardous for patients with vasospastic angina). I am afraid ignorance of vasospasm will cause major adverse cardiac events in many patients.