Jeon Hongki, Cho Jin-Man
Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea.
BMC Neurol. 2025 May 29;25(1):231. doi: 10.1186/s12883-025-04260-y.
Calcitonin gene-related peptide (CGRP) plays a pivotal role in migraine pathophysiology, and CGRP receptor antagonists are increasingly used for acute and preventive treatment. While considered to have minimal cardiovascular risk, real-world safety data remain limited, particularly in patients with cardiovascular comorbidities. We report a rare case of variant angina associated with atogepant, a novel oral CGRP receptor antagonist.
A 57-year-old woman presented with new-onset, paroxysmal chest pain over three days, described as a squeezing sensation with diaphoresis, typically occurring during early morning hours and relieved by sublingual nitroglycerin. She had a history of hypertension and IgA nephropathy and had been using zolmitriptan for chronic migraine for several years. Atogepant 60 mg once daily was initiated four days prior to reduce triptan use. On symptom onset, troponin I was mildly elevated but normalized by admission. Coronary angiography revealed no fixed stenosis or thrombosis. Given the clear clinical presentation, further spasm provocation testing was not performed, and variant angina was diagnosed. As no other causes of coronary vasospasm were identified, atogepant was discontinued, and diltiazem with a long-acting nitrate was prescribed. She remained symptom-free during follow-up.
This case suggests that atogepant may be associated with coronary vasospasm in patients with cardiovascular risk factors. Given CGRP's role as a potent vasodilator, its blockade may predispose to vasospasm in vulnerable individuals. Caution and close monitoring are warranted when prescribing CGRP receptor antagonists, particularly in those with cardiovascular comorbidities.
降钙素基因相关肽（CGRP）在偏头痛病理生理学中起关键作用，CGRP受体拮抗剂越来越多地用于急性和预防性治疗。虽然被认为心血管风险极小，但实际应用中的安全性数据仍然有限，尤其是在有心血管合并症的患者中。我们报告了1例与新型口服CGRP受体拮抗剂阿托格潘相关的变异型心绞痛罕见病例。
一名57岁女性在3天内出现新发阵发性胸痛，描述为压榨感并伴有出汗，通常发生在清晨，舌下含服硝酸甘油后缓解。她有高血压和IgA肾病病史，多年来一直使用佐米曲普坦治疗慢性偏头痛。4天前开始每日一次服用60mg阿托格潘以减少曲坦类药物的使用。症状发作时，肌钙蛋白I轻度升高，但入院时恢复正常。冠状动脉造影未发现固定狭窄或血栓形成。鉴于临床表现明确，未进行进一步的痉挛激发试验，诊断为变异型心绞痛。由于未发现冠状动脉痉挛的其他原因，停用阿托格潘，并开具了地尔硫䓬和长效硝酸盐类药物。随访期间她无症状。
该病例提示，阿托格潘可能与有心血管危险因素的患者发生冠状动脉痉挛有关。鉴于CGRP作为一种强效血管舒张剂的作用，其阻断可能使易感个体易发生血管痉挛。开具CGRP受体拮抗剂时应谨慎并密切监测，尤其是在有心血管合并症的患者中。
