Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection
Main finding · Long-term MACE, sex hormone therapy at index SCADResult — go to the resultAdjusted hazard ratio 1.88 95% CI 0.88–4.00Authors' conclusion
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.
Study context
- Population
- Females with spontaneous coronary artery dissection (SCAD) and core laboratory-adjudicated coronary angiography
- Participants
- 601 females
- Exposure
- Sex hormone therapy at index SCAD and post-SCAD sex hormone use, and major adverse cardiovascular events (MACE)
- Sex hormone therapy at index SCADn = 65/601
- Outcome
- Long-term MACE, sex hormone therapy at index SCAD
- Follow-up
- Median 13.7 (IQR: 2.5-35.6) months
Methodological detailsprospectively and retrospectively recruited, 23 sites in Australia and New Zealand, core laboratory-adjudicated coronary angiography
- Prospectively and retrospectively recruited
- 23 sites in Australia and New Zealand
- Core laboratory-adjudicated coronary angiography
Main finding
As reported in the abstract
Adjusted hazard ratio
1.88
95% CI 0.88–4.00
P = 0.130
Sex hormone therapy at index SCAD
adjusted HR 1.88 (95% CI 0.88–4.00); P = 0.130
Observational data: associations, not effects.
Further findings
Recurrent MACE, post-SCAD sex hormone use · median 13.7 (IQR: 2.5-35.6) months follow-up
| Adjusted HR (CI) | P value | ||
|---|---|---|---|
| Post-SCAD sex hormone use | 1.21 (0.35–4.16) | P = 0.770 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- No evidence of an association
Sex hormone therapy at index SCAD (descriptive)
- All 601 females with SCAD: Median age 53.0, IQR: 45.0 to
- 60.0
- Using sex hormone therapy at index SCAD
- 10.8% (65/601)
- Menopausal hormone therapy (MHT), of those using therapy
- 40.0%, 26/65
- Oral contraceptive pill, of those using therapy
- 32.3%, 21/65
- Nonoral contraceptives (NOCs), of those using therapy
- 23.1%, 15/65
- Combined therapy (MHT+NOC), of those using therapy
- 4.6%, 3/65
Sex hormone therapy reported (descriptive) · 3 years
- Reported sex hormone therapy
- 23.3% (7/30)
- NOC, of those reporting therapy
- 71.4%, 5/7
- MHT combined with NOC, of those reporting therapy
- 28.6%, 2/7
Original publication
Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection. JACC Adv. Published 5 August 2026. doi:10.
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