Coronary disease & ACSCohort study
Unveiling Phenotypic Heterogeneity in Coronary Spastic Angina Through Multidimensional Risk Profiling
- registry
- unsupervised k-means clustering
- adaptive least absolute shrinkage and selection operator regression followed by multivariable logistic regression
Authors' conclusion
CSA comprises distinct metabolic and inflammatory phenotypes with differing determinants of coronary spasm and endothelial dysfunction. Reduced HDL-C represents a shared vulnerability across phenotypes, while inflammation confers additional risk. HDL-C/hs-CRP-based stratification provides a clinically accessible framework for individualized CSA risk assessment.
Study context
- Population
- Patients with suspected coronary spastic angina (CSA) and no obstructive coronary artery disease from the FUJI-SPASM registryEndothelial function assessed by flow-mediated dilation in a subset of 159 patients · Cluster 0 231 · cluster 1 337
- Participants
- 568 patients
- Exposure
- Cluster 0 vs cluster 1
- Cluster 0n = 231
- cluster 1n = 337
Main finding
As reported in the abstract
Phenotypes identified
- Two phenotypes were identified
Observational data: associations, not effects.
Further findings
Determinants of coronary spasm
- Lower high-density lipoprotein cholesterol (HDL-C) was associated with coronary spasm in both clusters
- higher high-sensitivity C-reactive protein (hs-CRP) was independently associated with spasm only in the inflammation-dominant cluster
HDL-C/hs-CRP-based stratification
- graded increase in spasm prevalence and worsening endothelial function
Original publication
Unveiling Phenotypic Heterogeneity in Coronary Spastic Angina Through Multidimensional Risk Profiling. JACC Adv. doi:10.1016/j.jacadv.2026.102628
Summarised from the published abstract; every number is checked against it