Letter to the Editor
Risk factors for spontaneous coronary artery dissection
Factores de riesgo para la disección coronaria espontánea
a Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), The Dongguan Affiliated Hospital of Medical College of Jinan University, Dongguan, Guangdong, China
b Department of Pharmacy, Bin Hai Wan Central Hospital of Dongguan (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), The Dongguan Affiliated Hospital of Medical College of Jinan University, Dongguan, Guangdong, China
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SCAD is increasingly recognized as an important cause of acute coronary syndrome in young female patients, accounting for almost 35% of acute coronary syndrome in women aged 50 years old or less.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Conventional risk factors for coronary artery disease, such as smoking and hypertension, only have a weak association with SCAD.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Among women, almost one third of SCAD occur during pregnancy or in the postpartum period. It was reported that hormonally 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.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Zehir et al. previously reported a case of oral contraceptive pill use associated with SCAD.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It has been speculated that the hormones may be responsible for the increased incidence of SCAD among women particularly during the peripartum period or during the exogenous administration of hormones.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although various potential risk factors for SCAD have been discussed in Cepas-Guillén's study, the influence of exogenous hormone has not. However, clinical data have demonstrated that patients under either oral contraceptive use or hormone replacement therapy have an increased risk for developing SCAD.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Therefore, exogenous hormone should be discussed for studies in which the SCAD risks are evaluated. We are surprised that this potentially important risk factor has not been discussed, despite the known increase in SCAD risk with prior medical history of oral contraceptive use or hormone replacement therapy. Though exogenous hormone is now recognized to be associated with SCAD, it is still an uncommon occurrence, and this may have led to the delay in both presentation and diagnosis. Acute coronary syndrome in an otherwise healthy woman without traditional risk factors for coronary heart disease should raise the possibility of a SCAD especially if the patient is using oral contraceptives or having hormone replacement therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">If the effects of oral contraceptive use or hormone replacement therapy have been discussed in the study presented by Cepas-Guillén and colleagues, it would be of utmost interest to consider this risk factor to evaluate its potential contribution to the SCAD. Such knowledge would not only reinforce the clinical relevance of exogenous hormone effects on SCAD but also enable preventive recommendations.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack500696" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These two authors equally contributed to this work.</p>" "identificador" => "fn1" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous coronary artery dissection: not so infrequent to be ignored" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.L. Cepas-Guillén" 1 => "E. Flores-Umanzor" 2 => "M. Sabate" 3 => "M. Masotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2019.02.022" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous coronary artery dissection: revascularization versus conservative therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Tweet" 1 => "M.F. Eleid" 2 => "P.J. Best" 3 => "R.J. Lennon" 4 => "A. Lerman" 5 => "C.S. Rihal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.114.001659" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "777" "paginaFinal" => "786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25406203" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonatherosclerotic coronary artery disease in young women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Saw" 1 => "E. Aymong" 2 => "G.B. Mancini" 3 => "T. Sedlak" 4 => "A. Starovoytov" 5 => "D. Ricci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2014.01.011" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "814" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24726091" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial infarction and spontaneous dissection of coronary artery due to oral contraceptive" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Zehir" 1 => "C.Y. Karabay" 2 => "G. Kocabay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2459/JCM.0b013e3283467fc9" "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Med" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "448" "paginaFinal" => "450" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous coronary artery dissection associated with oral contraceptive use: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Evangelou" 1 => "K.P. Letsas" 2 => "P. Korantzopoulos" 3 => "I. Antonellis" 4 => "E. Sioras" 5 => "F. Kardaras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2005.07.069" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2006" "volumen" => "112" "paginaInicial" => "380" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16256224" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack500696" "titulo" => "Acknowledgments" "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">This paper is dedicated to my brilliant and beautiful wife, HuiQing Zhang. My wife always comforts and consoles, never complains or interferes, asks nothing, and endures all. She also writes the acknowledgments.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000011/v1_202012152105/S2387020620305325/v1_202012152105/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000011/v1_202012152105/S2387020620305325/v1_202012152105/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620305325?idApp=UINPBA00004N" ]
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