Variant angina associated with a CGRP receptor antagonist: a case report
Abstract Background 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, particular...
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BMC
2025-05-01
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| Online Access: | https://doi.org/10.1186/s12883-025-04260-y |
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| author | Hongki Jeon Jin-Man Cho |
| author_facet | Hongki Jeon Jin-Man Cho |
| author_sort | Hongki Jeon |
| collection | DOAJ |
| description | Abstract Background 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. Case presentation 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. Conclusions 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. |
| format | Article |
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| institution | OA Journals |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| spelling | doaj-art-d7e7b0758f93499397e1562fd68c63662025-08-20T02:00:01ZengBMCBMC Neurology1471-23772025-05-012511410.1186/s12883-025-04260-yVariant angina associated with a CGRP receptor antagonist: a case reportHongki Jeon0Jin-Man Cho1Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee UniversityDivision of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee UniversityAbstract Background 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. Case presentation 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. Conclusions 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.https://doi.org/10.1186/s12883-025-04260-yCGRP receptor antagonistAtogepantGepantsMigraineVariant anginaCoronary vasospasm |
| spellingShingle | Hongki Jeon Jin-Man Cho Variant angina associated with a CGRP receptor antagonist: a case report BMC Neurology CGRP receptor antagonist Atogepant Gepants Migraine Variant angina Coronary vasospasm |
| title | Variant angina associated with a CGRP receptor antagonist: a case report |
| title_full | Variant angina associated with a CGRP receptor antagonist: a case report |
| title_fullStr | Variant angina associated with a CGRP receptor antagonist: a case report |
| title_full_unstemmed | Variant angina associated with a CGRP receptor antagonist: a case report |
| title_short | Variant angina associated with a CGRP receptor antagonist: a case report |
| title_sort | variant angina associated with a cgrp receptor antagonist a case report |
| topic | CGRP receptor antagonist Atogepant Gepants Migraine Variant angina Coronary vasospasm |
| url | https://doi.org/10.1186/s12883-025-04260-y |
| work_keys_str_mv | AT hongkijeon variantanginaassociatedwithacgrpreceptorantagonistacasereport AT jinmancho variantanginaassociatedwithacgrpreceptorantagonistacasereport |