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Review
. 2025 Feb;18(2):226-239.
doi: 10.1016/j.jcmg.2024.05.024. Epub 2024 Aug 7.

Association Between Coronary Artery Spasm and Atherosclerotic Disease

Denise Peeters  1 , Eva Woelders  1 , Tijn Jansen  1 , Regina Konst  1 , Caïa Crooijmans  1 , Tim van de Hoef  2 , Frans Mensink  1 , Jonathan Los  1 , Dario Pellegrini  3 , Jan Hein Cornel  1 , Peter Ong  4 , Niels van Royen  1 , Aukelien Leen  1 , Suzette Elias-Smale  1 , Robert Jan van Geuns  1 , Peter Damman  5
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Free article
Review

Association Between Coronary Artery Spasm and Atherosclerotic Disease

Denise Peeters et al. JACC Cardiovasc Imaging. 2025 Feb.
Free article

Abstract

In at least one-half of the patients with angina or ischemia and nonobstructive coronary arteries undergoing coronary function testing, coronary artery spasm (CAS) is detected. CAS is associated with an adverse prognosis regarding recurrent complaints and ischemic events. Current treatment options are mainly focused on the complaints, not on the underlying pathophysiological process. In this review we discuss available evidence regarding the presence, amount, and morphology of atherosclerosis in CAS patients. The reviewed evidence confirmed that atherosclerosis and vulnerable plaque characteristics are often detected in patients with CAS. The amount of atherosclerosis is higher in patients with focal CAS compared with patients with diffuse CAS. Severity of atherosclerosis is associated with the presence of CAS and the prognosis in CAS patients with atherosclerotic stenosis is worse. Therefore, CAS patients with atherosclerosis might benefit from targeted atherosclerotic treatment. Longitudinal studies are needed to elucidate the exact relation between atherosclerosis and CAS.

Keywords: atherosclerosis; coronary spasm; prognosis; treatment.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Konst received a research grant from Abbott. Dr van de Hoef received speaker fees and institutional research grants from Abbott and Philips. Dr Ong received funding from the Berthold-Leibinger-Foundation; and received speaking honoraria from Philips/Volcano, Pfizer, Medtronic, Abbott, Amgen, and Bayer Healthcare. Dr van Royen received speaker fees from Abbott; and has received institutional research grants from Philips and Abbott. Dr Elias-Smale received a research grant from Abbott. Dr van Geuns received grants and personal fees from Boston Scientific, Abbott Vascular, AstraZeneca, Amgen, and Sanofi; and grants from InfraRedx. Dr Damman received research grants, consultancy, and speaker fees from Abbott; research grants and speakers fees from Abbott; and research grants from AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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