Coronary vasospasm (CVsp) plays an important role in the pathogenesis not only of variant angina but also of ischemic heart disease, including effort angina, unstable angina, acute myocardial infarction and sudden death.However, similarities and differences between CVsp and atherosclerotic coronary artery disease (CAD) are not known.We recently found that there is an interaction between smoking and high-sensitivity C-reactive protein (hs-CRP) in CVsp development.Therefore, we further retrospectively enrolled more patients to determine whether there was a gender difference in the development of CVsp and a secondary goal was to ascertain whether there were interactions among gender, age, hypertension and hs-CRP influencing the prediction of CVsp development among patients without obstructive CAD.In women, only the highest hs-CRP tertile (>3 mg/1) was independently associated with CVsp.In men, age >58 years and the highest hs-CRP tertile were independently associated with CVsp.In women, elevated risk was only demonstrated in patients ≤58 years with hs-CRP levels in the highest tertile.In men, a positively monotonic trend was demonstrated between hs-CRP levels and CVsp in those >58 years.The odds ratios of CVsp in both women and men with hs-CRP in the highest tertile reduced from 6.01 to 1.48 and 6.35 to 2.69, respectively, if they had hypertension.This study suggests that the relationship between hs-CRP and CVsp differed between men and women.Our findings that there is a non-threshold model in men and a threshold model in women provide evidence that more smokers in men (life-style) and age (induction time) contribute to the natural history of CVsp development.Furthermore, the negative effect of hypertension on CVsp suggests that the pathogenesis of CVsp differs from that of coronary atherosclerosis.