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- Kyu Tae Park1
Vasospastic angina is caused by vasospasm of the coronary arteries. Aldehyde dehydrogenase 2 (ALDH2) is as the ethanol degradation pathway involved in nitroglycerin metabolism and reduces oxidative stress, thereby suppressing vasospasm. It is unclear whether a change in the blood expression levels of ALDH2 correlates with the regulation of vasospastic angina. So, we investigated alcohol ingestion and the concentration of ALDH2 about how it affect vasospastic angina.
This was a prospective, single-center, observational study of 2,326 patients with angina who underwent coronary angiography between June 2011 and October 2014; of these, 195 patients underwent an intracoronary ergonovine provocation test because they presented symptoms indicative of vasospastic angina and proved for vasospastic angina.
Angina symptoms induced by alcohol ingestion were noted in 13.3% of patients, half of whom had a positive response to ergonovine provocation. Vasospastic angina (i.e., positive response to ergonovine provocation) was noted in 39.0% of patients, who also had a higher difference between the pre-and post-test ALDH2 concentration (-10.00 ± 4.53 vs -4.49 ± 3.47 ng/mL in patients with a negative response; p=0.03). Multivariate analysis revealed that vasospastic angina was significantly more prevalent in male subjects (odds ratio, 2.32; 95% confidence interval, 1.02–5.28).
The prevalence of angina symptoms induced by alcohol ingestion was 13.3%, and 50% of these patients had a positive response to ergonovine provocation. Furthermore, baseline ALDH2 levels were more elevated in patients with a positive response, and the difference in pre- and post-activation levels of ALDH2 was much larger in these patients. Finally, male sex was an independent risk factor for vasospastic angina in elderly patients (age≥65 years), whereas age was an independent risk factor only in middle-aged patients (age<65 years). We hope that our results will help clinicians to determine optimal therapeutic approaches for vasospastic angina.