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Peer-reviewedCC BYJACC: Advances

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

  • Masoud Shahsavar Haghighi, BSc(Med)1
  • Hansaem Jung, BSc1
  • Mithila Zaheen, MBBS2
  • Quan M. Dang, MD, PhD3
  • Patrick Pender, MBBS4
  • Jaya Chandrasekhar, MBBS, PhD5
  • Peter J. Psaltis, MBBS(Hons), PhD6
  • Sonya Burgess, MBChB, PhD7
  • Swati Mukherjee, MBBS, PhD8
  • David Makarious, MD2
  • Leonard Kritharides, MBBS, PhD9
  • Sarah Fairley, MBBS, PhD10
9 more authors
  • Abdul Ihdayhid, MBBS(Hons), PhD11
  • Aniket Puri, MBBS, MD12
  • Esther Davis, MBBS, PhD13
  • Hui Zhen Lo, MD14
  • Monique Watts, MBBS14
  • Tom Ford, MBChB(Hons), PhD15
  • Kamran Majeed, MBBS, PhD16
  • Sarah Zaman, MBBS, PhD2
  • Simone Marschner, PhD17
17 affiliations
  1. 1Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
  2. 2Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
  3. 3Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
  4. 4Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Liverpool Hospital, Sydney, Australia
  5. 5Department of Cardiology, Box Hill Hospital, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia
  6. 6College 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
  7. 7Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Nepean Hospital, Sydney, Australia
  8. 8Department of Cardiology, Cabrini Hospital, Malvern, Australia
  9. 9Sydney 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
  10. 10Department of Cardiology, Wellington Hospital, Wellington, New Zealand
  11. 11Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Curtin Medical School, Curtin University, Perth, Australia
  12. 12Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
  13. 13Victorian Heart Institute, Monash University, Melbourne, Australia; Department of Cardiology, Victorian Heart Hospital, Melbourne, Australia
  14. 14Department of Cardiology, Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
  15. 15The University of Newcastle - Central Coast Clinical School, Gosford, Australia
  16. 16Department of Cardiology, Waikato Hospital, Hamilton, New Zealand; New Zealand Graduate School of Medicine, The University of Waikato, New Zealand
  17. 17Westmead Applied Research Centre, University of Sydney, Sydney, Australia
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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.

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Cite

BibTeXRIS
BibTeX
@article{masoudshahsavarhaghighi2026risks,
  title = {{Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection}},
  author = {Masoud Shahsavar Haghighi, BSc(Med) and Hansaem Jung, BSc and Mithila Zaheen, MBBS and Quan M. Dang, MD, PhD and Patrick Pender, MBBS and Jaya Chandrasekhar, MBBS, PhD and Peter J. Psaltis, MBBS(Hons), PhD and Sonya Burgess, MBChB, PhD and Swati Mukherjee, MBBS, PhD and David Makarious, MD and Leonard Kritharides, MBBS, PhD and Sarah Fairley, MBBS, PhD and Abdul Ihdayhid, MBBS(Hons), PhD and Aniket Puri, MBBS, MD and Esther Davis, MBBS, PhD and Hui Zhen Lo, MD and Monique Watts, MBBS and Tom Ford, MBChB(Hons), PhD and Kamran Majeed, MBBS, PhD and Sarah Zaman, MBBS, PhD and Simone Marschner, PhD},
  journal = {JACC: Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103128},
  url = {https://doi.org/10.1016/j.jacadv.2026.103128},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Risks of Exogenous Sex Hormone Therapy Before and After Spontaneous Coronary Artery Dissection
AU  - Masoud Shahsavar Haghighi, BSc(Med)
AU  - Hansaem Jung, BSc
AU  - Mithila Zaheen, MBBS
AU  - Quan M. Dang, MD, PhD
AU  - Patrick Pender, MBBS
AU  - Jaya Chandrasekhar, MBBS, PhD
AU  - Peter J. Psaltis, MBBS(Hons), PhD
AU  - Sonya Burgess, MBChB, PhD
AU  - Swati Mukherjee, MBBS, PhD
AU  - David Makarious, MD
AU  - Leonard Kritharides, MBBS, PhD
AU  - Sarah Fairley, MBBS, PhD
AU  - Abdul Ihdayhid, MBBS(Hons), PhD
AU  - Aniket Puri, MBBS, MD
AU  - Esther Davis, MBBS, PhD
AU  - Hui Zhen Lo, MD
AU  - Monique Watts, MBBS
AU  - Tom Ford, MBChB(Hons), PhD
AU  - Kamran Majeed, MBBS, PhD
AU  - Sarah Zaman, MBBS, PhD
AU  - Simone Marschner, PhD
PY  - 2026
DA  - 2026/10/30
JO  - JACC: Advances
DO  - 10.1016/j.jacadv.2026.103128
UR  - https://doi.org/10.1016/j.jacadv.2026.103128
AB  - 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.
SN  - 2772-963X
ER  -