Hormone-associated spontaneous coronary artery dissection

Hormone-associated spontaneous coronary artery dissectionTo the Editor We read with interest Plonczak et al's 1 article depicting the two-vessel spontaneous coronary artery dissection (SCAD) as a cause of acute coronary syndrome (ACS).SCAD is uncommon, accounting for 0.1-0.28% of all patients with ACS or sudden cardiac death.It is more common in young female patients with an average age of 35-44 years at initial presentation.Conventional coronary risk factors, such as smoking and hypertension, have a weak association with SCAD. 2 Among women, almost one third of SCAD occur during pregnancy or in the postpartum period.Moreover, we previously reported a case of oral contraceptive pill OCP use associated with SCAD. 3 Hormonally (particularly progesterone) induced degeneration of collagen, fragmentation of reticulin fibres along with decreased mucopolysaccharide content of the arterial media and haemodynamic changes are thought to play a role in hormone-associated SCAD.According to the National Health Service in the UK, where the study was conducted, the average age for a woman to reach menopause is 52.In conclusion, taking into consideration all data from the literature -weak association with hypertension and the importance of the hormone therapy-it would be of interest to know whether the patient was under either OCS or hormone replacement therapy.