Neural control of coronary artery blood flow by non‐adrenergic and non‐cholinergic mechanisms

New Findings What is the topic of this review? How non‐adrenergic, non‐cholinergic neural mechanisms regulate coronary artery blood flow. What advances does it highlight? The main coronary arteries dynamically adapt to maintain adequate blood flow to the working myocardium. There is growing evidence for an important role of non‐classic neurotransmitters in regulating coronary blood flow. This review highlights current evidence for non‐adrenergic, non‐cholinergic control of coronary artery blood flow and our understanding of the dynamics of this system. Abstract Blood flow through the coronary vasculature is essential to maintain myocardial function. As the metabolic demand of the heart increases, so does blood flow through the coronary arteries in a dynamic and adaptive manner. Several mechanisms, including local metabolic factors, mechanical forces and autonomic neural control, regulate coronary artery blood flow. To date, neural control has predominantly focused on the classical neurotransmitters of noradrenaline and acetylcholine. However, autonomic nerves, sympathetic, parasympathetic and sensory, release a variety of neurotransmitters that can directly affect the coronary vasculature. Reduced or altered coronary blood flow and autonomic imbalance are hallmarks of most cardiovascular diseases. Understanding the role of autonomic non‐adrenergic, non‐cholinergic cotransmitters in coronary blood flow regulation is fundamental to furthering our understanding of this vital system and developing novel targeted therapies.