Vericiguat in Patients With Metabolic Syndrome and Coronary Vascular Dysfunction

Inclusion Criteria: * Age range 35-85 years * Presence of the metabolic syndrome defined by the National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) definition, with at least three of the following five criteria: * waist circumference \> 40 inches (men) or \>35 inches (women) * blood pressure \>130/80 mmHg * fasting triglyceride (TG) level \>150 mg/dL * fasting high-density lipoprotein (HDL) cholesterol level \<40mg/dL in men or \<50mg/dL in women * Fasting blood glucose \>100 mg/dL, or hemoglobin A1c greater or equal to 5.7% * Either one of the following: * Men ≤ 40 or women ≤ 50 years of age with no history or symptoms of ischemic heart disease, or * Men \>40 or women \>50 years of age with either one of the following * a coronary angiography within the past 24 months showing no significant coronary artery disease in a t least one major vessel, defined as \>50% stenosis of the left main coronary artery and/or \>70% stenosis of another major coronary vessel, or * a coronary artery calcium score obtained within the prior 24 months or if no prior calcium scan, one performed as a research study following consent with a Agatston score \<10 in at least one major coronary vessel. * IHE-induced %-change in coronary flow ≤13% Exclusion Criteria: * Systolic blood pressure \<110 mm Hg * Current or anticipated use of long-acting nitrates, soluble guanylate cyclase (sGC) stimulators, or phosphodiesterase type 5 (PDE5) inhibitors * …