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Despite the high prevalence of this diagnosis in patients undergoing coronary angiography, it is still a therapeutic challenge for cardiologists. Unlike obstructive coronary artery disease, with multiple evidence-based therapies and management guidelines, little is known regarding the management of MVA. During the last decade, many therapeutic interventions have been suggested for the treatment of MVA. However, there is a lack of summarization tab and update of current knowledge about pharmacologic management of MVA, mostly due to unclear pathophysiology. In this article, we have reviewed the underlying mechanisms of MVA and the outcomes of various medications in patients with this disease. Contrary to vasospastic angina in which normal angiogram is observed as well, nitrates are not effective in the treatment of MVA. Beta-blockers and calcium channel blockers have the strongest evidence of improving the symptoms. Moreover, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, estrogen, and novel antianginal drugs has had promising outcomes. Investigations are still ongoing for vitamin D, omega-3, incretins, and n-acetyl cysteine, which have resulted in beneficial initial outcomes. We believe that the employment of the available results and results of the future large-scale trials into cardiac care guidelines would help reduce the global cost of cardiac care tremendously.<\/jats:p>","DOI":"10.1155\/2022\/6080258","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T18:20:14Z","timestamp":1666722014000},"page":"1-19","source":"Crossref","is-referenced-by-count":16,"title":["Updates on Pharmacologic Management of Microvascular Angina"],"prefix":"10.1155","volume":"2022","author":[{"given":"Mosayeb","family":"Soleymani","sequence":"first","affiliation":[{"name":"Students\u2019 Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8098-7121","authenticated-orcid":true,"given":"Farzad","family":"Masoudkabir","sequence":"additional","affiliation":[{"name":"Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-659X","authenticated-orcid":true,"given":"Mahsima","family":"Shabani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3346-2124","authenticated-orcid":true,"given":"Ali","family":"Vasheghani-Farahani","sequence":"additional","affiliation":[{"name":"Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9955-4227","authenticated-orcid":true,"given":"Amir Hossein","family":"Behnoush","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-1914","authenticated-orcid":true,"given":"Amirmohammad","family":"Khalaji","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(73)80150-X"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.08.068"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.114198"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907272"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.04.061"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.14503\/THIJ-16-5906"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1177\/2048872618764418"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.50"},{"key":"9","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/978-1-4471-4838-8_26","article-title":"Impaired quality of life\u2013causes, assessment and management","volume-title":"Chest Pain with Normal Coronary Arteries","author":"T. 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