New Research Reveals Menopausal and Young Women Face Heightened SCAD Heart Attack Risk
Thousands of healthy young women who are not pregnant, along with those undergoing menopause, could be at increased risk of sudden heart attacks due to a poorly understood condition known as spontaneous coronary artery dissection (SCAD). This unusual cardiovascular event most commonly affects individuals with no obvious risk factors for heart disease, challenging conventional medical assumptions.
Understanding the SCAD Mechanism
SCAD occurs when one or more inner layers of a coronary artery tear away from the outer layer. These arteries are responsible for supplying blood to the heart muscle. When such a tear develops, blood flows into the resulting gap and forms a clot, significantly reducing blood flow to the heart. This dangerous situation can lead directly to a heart attack or even cardiac arrest, where the heart suddenly stops pumping blood throughout the body.
Previously, medical experts believed SCAD risk was primarily linked to extreme physical exertion, pregnancy, or labour. However, groundbreaking research from the University Clinical Center Niš in Serbia now indicates that the threat extends far beyond these specific circumstances.
Key Findings from the Serbian Study
Presenting their findings at the European Association of Percutaneous Cardiovascular Interventions Summit, Professor Svetlana Apostolović stated: 'SCAD is an increasingly recognised cause of acute coronary syndrome, but it remains poorly understood. It remains under-diagnosed and under-studied with few, if any, randomised trials conducted to define the most appropriate treatment approach.'
The research team analysed data from 123 patients on the Serbian SCAD registry, treated at 14 specialist heart centres between November 2021 and 2024. Intracoronary imaging techniques confirmed SCAD diagnoses in 26 percent of these patients. The study revealed several critical patterns:
- More than 85 percent of those diagnosed were women, with an average age of 48.
- Approximately 7 percent were pregnant or had recently given birth.
- Over one-third of the diagnosed women were menopausal.
- Half of the SCAD patients had high blood pressure, despite most lacking traditional heart disease risk factors like smoking, diabetes, or high cholesterol.
- High cholesterol was identified in 46 percent of participants.
Triggers and Treatment Challenges
The researchers emphasised that SCAD is fundamentally spontaneous, making it difficult to predict. Where triggers were identified following a heart event, the most common contributing factors were mental or emotional stress, affecting nearly 40 percent of patients, followed by physical exertion.
Treatment approaches varied depending on symptom severity. More than half of the study participants received medication to prevent blood clots, while just over 40 percent underwent procedures to open the affected artery, often involving stent insertion to improve blood flow.
During hospitalisation, approximately a quarter of patients suffered a major cardiac event such as another heart attack, heart failure, or stroke, with 8 percent of these events proving fatal. In the 30 days following discharge, less than 20 percent experienced a major heart event, with higher incidence among those who had received stents or suffered from depression.
Improving Outcomes and Future Research
Professor Apostolović highlighted potential strategies for better patient management: 'Careful observation alongside beta-blockers, blood pressure lowering medication, cardiac rehabilitation and psychological support may improve outcomes and reduce the impact on patients' daily lives, but more studies and trials are needed.'
The study underscores that blood-pressure monitoring, appropriate medication, and psychological support following a major heart event could significantly improve outcomes and reduce recurrence risk for these vulnerable patient groups.
The Broader Cardiovascular Context
Cardiovascular disease remains one of the leading global causes of death, claiming an estimated 17.9 million lives annually. In the UK alone, at least four SCAD-related heart attacks occur daily, suggesting approximately 1,400 people could suffer these potentially life-threatening events each year from this little-known condition.
Common SCAD symptoms mirror those of traditional heart attacks, including:
- Chest pain, tightness, or discomfort
- Pain radiating to the arms, neck, jaw, or back
- Dizziness, fatigue, or shortness of breath
- Nausea
This research arrives amid growing concerns about increasing heart attack rates among younger populations. Factors such as delayed ambulance responses for category 2 emergency calls (which include suspected heart attacks and strokes) and lengthy waits for diagnostic tests and treatment have been cited as contributing to this troubling trend.
