Study to Evaluate Effect of Nebivolol on Angina in Women With Microvascular Disease
Condition: Microvascular Angina
MeSH terms: Angina Pectoris; Microvascular Angina
Intervention: Nebivolol
Intervention description: Patient to start nebivolol and have repeat testing in 3 months
Intervention MeSH terms: Nebivolol
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 12.0
Sex: Female
Minimum age: 40 Years
Maximum age: 80 Years
Healthy volunteers: No
Keywords: angina; cardiopulmonary testing; metabolomics; nebivolol

Summary:

      Women have less significant blockages of coronary arteries, however have greater symptoms and
      worse outcomes compared to their age-matched male counterparts. This paradox has led to the
      recognition and importance of the microvasculature ( small vessels) as a contributor to
      symptoms and outcomes. Nebivolol has unique antioxidant properties and dilates blood vessels
      and it is therefore proposed that treatment with nebivolol will reduce angina (chest
      symptoms) in women with microvascular disease as well as improve exercise capacity, reduce
      resource utilization and improve other measures of artery function.
    

Eligibility criteria:

        Inclusion Criteria:

          -  women between the ages of 40-80

          -  with evidence of coronary microvascular dysfunction as determined by the presence of
             rest and or exertional chest tightness and a history of either an elevated troponin
             level or positive stress test ( EKG criteria or imaging) , as well as non-obstructive
             coronary artery disease (<50% epicardial obstruction) by either diagnostic
             catheterization with coronary angiography or CT angiography.

        Exclusion Criteria:

          -  Women who cannot tolerate a beta blocker.

          -  Women receiving Hormone Replacement Therapy

          -  Women of child-bearing age who are not on a birth-control method.

          -  Women with inability to exercise.

          -  Women with left ventricular systolic dysfunction (LVEF less than 40%)

          -  Women who have a medical condition that, in the Investigator's opinion, would expose
             them to an increased risk of a significant adverse event or interfere with assessments
             of safety and efficacy during the course of the trial.

          -  Women with any current malignancy, or any clinically significant hematological,
             endocrine, cardiovascular, renal, hepatic, gastrointestinal or neurological disease.
             If there is a history of such disease but the condition has been stable for at least
             the past year and is judged by the investigator not to interfere with the patient's
             participation in the study, the patient may be included.

          -  Women who are unable to speak, read, and understand English and are judged by the
             investigator to be unable or unlikely to follow the study protocol and complete all
             scheduled visits.

          -  Women with any contraindications to beta blocker therapy

          -  Women with myocardial bridging

          -  Women with Prinzmetal's angina