{"id":"94859f895c9c","type":"article","url":"https://hartvaat.nl/2026/11/01/mechanismegerichte-therapie-bij-inoca-vasospastische-angina-en-microvasculaire-d/","title":"Mechanismegerichte therapie bij INOCA, vasospastische angina en microvasculaire dysfunctie","title_en":"Current Medical Therapy in Epicardial and Microvascular Disease: Evidence and Gaps.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Cardiology clinics","doi":"10.1016/j.ccl.2026.07.002","source_url":"https://doi.org/10.1016/j.ccl.2026.07.002","authors":["Francesco Angeli","Matteo Armillotta","Luca Bergamaschi","Carmine Pizzi"],"significance":6,"published":"2026-10-11","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The management of chronic coronary syndromes is shifting from an obstructive to a phenotype-guided approach, encompassing INOCA, vasospastic angina, and coronary microvascular dysfunction. While foundational therapies like statins, ACE inhibitors, and SGLT2 inhibitors support vascular health, the WARRIOR trial underscores the limitations of intensive treatment in unselected INOCA patients. This review advocates for mechanism-based anti-ischemic therapy, recommending calcium channel blockers for vasospasm, beta-blockers or ranolazine for microvascular dysfunction, and cautioning against nitrates in microvascular disease. Adopting this targeted approach enables clinicians to optimize symptom control and reserve invasive interventions for appropriate phenotypes.","created":"2026-10-04T01:04:41Z","updated":"2026-10-04T01:04:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De behandeling van chronisch coronairlijden verschuift naar een fenotypegerichte aanpak voor INOCA, vasospastische angina en microvasculaire dysfunctie. Hoewel basismedicatie zoals statinen, ACE-remmers en SGLT2-remmers de vaatgezondheid ondersteunt, wijst de WARRIOR-trial op de beperkingen van intensieve therapie bij ongescreende INOCA-patiënten. Het overzicht pleit voor mechanismegerichte anti-ischemische medicatie: calciumantagonisten bij vasospasme, bètablokkers of ranolazine bij microvasculaire dysfunctie, en waarschuwt voor nitraten bij microvasculaire ziekte. Dit helpt klinici om symptomen gerichter te behandelen en invasieve ingrepen te selecteren op basis van pathofysiologie.","abstract_original":"Management of chronic coronary syndromes has shifted from an obstructive coronary artery disease-focused model to a phenotype-guided approach that includes angina with nonobstructive coronary arteries/ ischemia with nonobstructive coronary arteries (INOCA), vasospastic angina (VSA), and coronary microvascular dysfunction (CMD). Background therapies such as statins, angiotensin-converting enzyme inhibitors, antiplatelets, and sodium-glucose cotransporter-2 inhibitor inhibitors improve vascular health, but the WARRIOR trial highlighted the limits of intensive therapy in unselected INOCA patients. Anti-ischemic treatment should be mechanism-based: calcium channel blockers for VSA, beta-blockers and ranolazine for CMD, while nitrates may worsen microvascular disease."}