Statin treatment improves endothelial dysfunction and decreases plaque volume in patients with obstructive coronary artery disease (OCAD) as a pleiotropic mechanism. Clinical outcomes in patients with OCAD under statin therapy are favorable compared with those outcomes for patients without statins. However, the effect of statins may be uncertain in patients with vasospastic angina and nonobstructive coronary artery disease (VSA-NOCAD). Several researchers in South Korea and Japan have reported on the effectiveness of statin therapy in patients with VSA-NOCAD. Flow-mediated dilatation was shown to be improved in VSA patients with statins compared with patients without statins. However, statin treatment was shown to not be effective in reducing the major cardiovascular events (MACEs) in patients with VSA-NOCAD, although after propensity score matching, the prognosis was better in patients with VSA-NOCAD. Furthermore, high-intensity statin therapy showed no clinical utility for mitigating MACEs in patients with VSA-NOCAD.