{
  "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.",
  "abstract_shown": true,
  "affiliations": [
    "Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia",
    "Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia",
    "Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Waikato Hospital, Hamilton, New Zealand",
    "Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Liverpool Hospital, Sydney, Australia",
    "Department of Cardiology, Box Hill Hospital, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia",
    "College of Health, Adelaide University, Adelaide, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia",
    "Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Nepean Hospital, Sydney, Australia",
    "Department of Cardiology, Cabrini Hospital, Malvern, Australia",
    "Sydney Medical School, University of Sydney, Sydney, Australia; ANZAC Medical Research Institute, Sydney, New South Wales, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia",
    "Department of Cardiology, Wellington Hospital, Wellington, New Zealand",
    "Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Curtin Medical School, Curtin University, Perth, Australia",
    "Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand",
    "Victorian Heart Institute, Monash University, Melbourne, Australia; Department of Cardiology, Victorian Heart Hospital, Melbourne, Australia",
    "Department of Cardiology, Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia",
    "The University of Newcastle - Central Coast Clinical School, Gosford, Australia",
    "Department of Cardiology, Waikato Hospital, Hamilton, New Zealand; New Zealand Graduate School of Medicine, The University of Waikato, New Zealand",
    "Westmead Applied Research Centre, University of Sydney, Sydney, Australia"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Masoud Shahsavar Haghighi, BSc(Med)"
    },
    {
      "affs": [
        0
      ],
      "name": "Hansaem Jung, BSc"
    },
    {
      "affs": [
        1
      ],
      "name": "Mithila Zaheen, MBBS"
    },
    {
      "affs": [
        2
      ],
      "name": "Quan M. Dang, MD, PhD"
    },
    {
      "affs": [
        3
      ],
      "name": "Patrick Pender, MBBS"
    },
    {
      "affs": [
        4
      ],
      "name": "Jaya Chandrasekhar, MBBS, PhD"
    },
    {
      "affs": [
        5
      ],
      "name": "Peter J. Psaltis, MBBS(Hons), PhD"
    },
    {
      "affs": [
        6
      ],
      "name": "Sonya Burgess, MBChB, PhD"
    },
    {
      "affs": [
        7
      ],
      "name": "Swati Mukherjee, MBBS, PhD"
    },
    {
      "affs": [
        1
      ],
      "name": "David Makarious, MD"
    },
    {
      "affs": [
        8
      ],
      "name": "Leonard Kritharides, MBBS, PhD"
    },
    {
      "affs": [
        9
      ],
      "name": "Sarah Fairley, MBBS, PhD"
    },
    {
      "affs": [
        10
      ],
      "name": "Abdul Ihdayhid, MBBS(Hons), PhD"
    },
    {
      "affs": [
        11
      ],
      "name": "Aniket Puri, MBBS, MD"
    },
    {
      "affs": [
        12
      ],
      "name": "Esther Davis, MBBS, PhD"
    },
    {
      "affs": [
        13
      ],
      "name": "Hui Zhen Lo, MD"
    },
    {
      "affs": [
        13
      ],
      "name": "Monique Watts, MBBS"
    },
    {
      "affs": [
        14
      ],
      "name": "Tom Ford, MBChB(Hons), PhD"
    },
    {
      "affs": [
        15
      ],
      "name": "Kamran Majeed, MBBS, PhD"
    },
    {
      "affs": [
        1
      ],
      "name": "Sarah Zaman, MBBS, PhD"
    },
    {
      "affs": [
        16
      ],
      "name": "Simone Marschner, PhD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/65ma9e5jzj1kn.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103128",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2772963X26005491",
  "id": "65ma9e5jzj1kn",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://doi.org/10.1016/j.jacadv.2026.103128",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC666-701"
    ],
    [
      "lcc",
      "RC86-88.9"
    ],
    [
      "openalex",
      "2705|Cardiovascular Issues in Pregnancy"
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  "openalex": "W7154891129",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/65ma9e5jzj1kn.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T14:22:44Z",
      "native_id": "0dace268ad0a4deeb0ce8f337ac5c88c",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.jacadv.2026.103128"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiovascular Issues in Pregnancy",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection",
  "title_text": "Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T14:20:43Z",
  "url": "https://research.draconitic.com/paper/65ma9e5jzj1kn",
  "venue": "JACC: Advances",
  "versions": []
}