Coronary Artery Spasm in Patients with Type 2 Diabetes Mellitus

Cardiovascular disease and diabetes mellitus have now reached pandemic proportions, and their association has become very common. Some patients with coronary artery disease and diabetes remain symptomatic, with chest pain present despite the implementation of evidence-based medical treatment and maximal therapy. A hypothesis increasingly confirmed in clinical practice is that epicardial or microvascular spasm, or both, are frequently responsible for the lack of symptom control or for the occurrence of major adverse cardiovascular events. Our review provides the most up-to-date and in-depth analysis of the available literature to provide solid knowledge about coronary spasm in diabetes patients. We have deepened the substrate of coronary spasm in relation to the multiple and complex structural and functional abnormalities produced by chronic hyperglycemia, with the ultimate goal of allowing optimization of treatment and improving patient outcomes.