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Coronary disease & ACS

Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection

JACC AdvPublished

Main finding · Long-term MACE, sex hormone therapy at index SCADAdjusted hazard ratio 1.88 95% CI 0.88–4.00
  • Cohort study
  • prospectively and retrospectively recruited
  • 23 sites in Australia and New Zealand
  • core laboratory-adjudicated coronary angiography
+3 more
  • prospectively and retrospectively recruited
  • 23 sites in Australia and New Zealand
  • core laboratory-adjudicated coronary angiography
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Authors' 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

Main finding

As reported in the abstract

Long-term MACE, sex hormone therapy at index SCAD · median 13.7 (IQR: 2.5-35.6) months follow-up

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

Comparisonadjusted HR (CI)P value
Post-SCAD sex hormone use1.21 (0.35–4.16)P = 0.770
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:10.1016/j.jacadv.2026.103128
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Summarised from the published abstract; every number is checked against it