Differences in cardiovascular risk profiles between patients with obstructive coronary artery disease and ANOCA patients with coronary vasomotor dysfunction: insights from two multicentre registries

Background Obstructive coronary artery disease (CAD) and angina without obstructive coronary arteries (ANOCA) caused by coronary vasomotor dysfunction (CVDys) are distinct ischemic entities, yet comparative data on their cardiovascular risk profiles are limited. Purpose Understanding potential differences may improve risk stratification and inform tailored preventive strategies in patients with ischemic symptoms. Methods This observational study included patients with chronic coronary syndrome (CCS) from two prospective, multicentre all-comer registries in the Netherlands: the south-east Netherlands Heart Registry (ZON-HR), comprising patients undergoing percutaneous coronary intervention (PCI) for obstructive CAD, and the Netherlands registry of invasive Coronary vasomotor Function Testing (NL-CFT), including ANOCA patients who underwent a clinically indicated coronary function test (CFT). The prevalence of risk factors in CCS patients with obstructive CAD were compared with the prevalence in ANOCA patients with CVDys, defined as an abnormal CFT outcome. Results ANOCA patients with CVDys were younger (60 vs 69 years) and predominantly female (83% vs 27%) compared with patients with obstructive CAD. Traditional cardiovascular risk factors and prior atherosclerotic diseases were markedly more prevalent in obstructive CAD (table 1). Mean low density lipoprotein cholesterol (LDL-C) levels were comparable between groups (2.4 ± 2.2 vs 2.4 ± 0.9 mmol/L), despite substantially higher use of statins and ezetimibe in obstructive CAD (80.7% vs 48.5% and 16.5% vs 11.2%, respectively) (table 2). Conclusion Obstructive CAD and ANOCA caused by CVDys represent clearly distinct clinical phenotypes with evidently different cardiovascular risk profiles and treatment patterns. Although lipid-lowering therapy was more intensively prescribed in obstructive CAD, LDL-C levels remained above ESC guideline recommended targets (<1.4 mmol/L), suggesting a potential treatment gap in secondary prevention. In contrast, ANOCA appears less driven by traditional atherosclerotic risk factors, underscoring the heterogeneous mechanisms underlying ischemic symptoms.Table 1.Risk factorsTable 2.Cardiac medication