Coronary artery spasm (CAS) plays an important role in the pathogenesis of ischemic heart disease, including angina pectoris, myocardial infarction, and sudden death, occurring most often from midnight to early morning. CAS is prevalent among East Asians and is associated with an aldehyde dehydrogenase 2 (ALDH2)-deficient genotype (ALDH2*2) and alcohol flushing, which is prevalent among East Asians but is virtually non-existent in other populations. ALDH2 eliminates not only acetaldehyde but also other toxic aldehydes from lipid peroxidation and tobacco smoking, thereby protecting tissues and cells from oxidative damage. Risk factors for CAS include smoking and genetic polymorphisms including those of ALDH2*2, endothelial NO synthase, paraoxonase I, and interleukin-6. Accordingly, oxidative stress, endothelial dysfunction, and low-grade chronic inflammation play an important role in the pathogenesis of CAS, leading to increased coronary smooth muscle Ca2+ sensitivity through RhoA/ROCK activation and resultant hypercontraction. Ca-channel blockers blocking the intracellular entry of Ca2+ are specifically effective for treatment for CAS.

中文翻译：

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冠状动脉痉挛-临床特征，发病机制和治疗方法。

冠状动脉痉挛（CAS）在缺血性心脏病的发病机理中起重要作用，包括心绞痛，心肌梗塞和猝死，其发生时间通常是从午夜到清晨。CAS在东亚人中普遍存在，并且与缺乏醛脱氢酶2（ALDH2）的基因型（ALDH2 * 2）和潮红有关，这在东亚人中普遍存在，但在其他人群中实际上不存在。ALDH2不仅可以消除脂质过氧化和吸烟带来的乙醛，还可以消除其他有毒的醛，从而保护组织和细胞免受氧化损伤。CAS的危险因素包括吸烟和遗传多态性，包括ALDH2 * 2，内皮NO合酶，对氧磷酶I和白介素-6。因此，氧化应激，内皮功能障碍，低度慢性炎症在CAS的发病机理中起重要作用，通过RhoA / ROCK激活和过度收缩导致冠状动脉平滑肌Ca2 +敏感性增加。阻止Ca2 +进入细胞内的Ca通道阻滞剂对CAS的治疗特别有效。