Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in females. The impact of exogenous sex hormone therapy on major adverse cardiovascular events (MACE) remains uncertain. OBJECTIVES: This study estimated the effect of sex hormone therapy on MACE. METHODS: Females with SCAD and core laboratory-adjudicated coronary angiography were prospectively and retrospectively recruited from 23 sites in Australia and New Zealand. Cox proportional hazard modes estimated if sex hormone therapy at the index SCAD predicted long-term MACE. In the prospective cohort, post-SCAD sex hormone therapy was modeled as a time-varying covariate to assess for association with recurrent MACE. RESULTS: Among 601 females (median age: 53.0, IQR: 45.0 to 60.0), 10.8% (65/601) were using sex hormone therapy at the index SCAD, comprising menopausal hormone therapy (MHT) (40.0%, 26/65), oral contraceptive pill (32.3%, 21/65), nonoral contraceptives (NOCs) (23.1%, 15/65), and combined therapy (MHT+NOC; 4.6%, 3/65). There was no evidence of an association between sex hormone therapy at index SCAD and long-term MACE (adjusted HR: 1.88; 95% CI: 0.88-4.00; P = 0.130) nor between post-SCAD sex hormone use and recurrent MACE (adjusted HR: 1.21; CI: 0.35-4.16; P = 0.770), after median 13.7 (IQR: 2.5-35.6) months follow-up. At 3 years, 23.3% (7/30) reported sex hormone therapy, mainly NOC (71.4%, 5/7) and MHT combined with NOC (28.6%, 2/7). CONCLUSIONS: Exogenous sex hormone therapy was not associated with an increase in MACE in females with SCAD, including when initiated after SCAD, where lower-dose intrauterine devices predominated. These findings support an individualized approach to sex hormone therapy after SCAD, although wide CIs highlight the need for further study.
Source: JACC Advances
Authors: Masoud Shahsavar Haghighi, Hansaem Jung, Mithila Zaheen, Quan M. Dang, Patrick Pender, Jaya Chandrasekhar, Peter J. Psaltis, Sonya Burgess, Swati Mukherjee, David Makarious, Leonard Kritharides, Sarah Fairley, Abdul Ihdayhid, Aniket Puri, Esther Davis, Hui Zhen Lo, Monique Watts, Tom Ford, Kamran Majeed, Sarah Zaman, Simone Marschner
Institutions: The University of Sydney, Westmead Hospital, Waikato Hospital, Liverpool Hospital, Box Hill Hospital, Eastern Health, Monash University, South Australian Health and Medical Research Institute, Central Adelaide Local Health Network, Adelaide University, Nepean Hospital, Cabrini Hospital, Concord Repatriation General Hospital, Anzac Research Institute, Wellington Hospital, Curtin University, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Christchurch Hospital, The University of Melbourne, The Alfred Hospital, University of Newcastle Australia, University of Waikato
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W7154891129