P307 - HORMONE REPLACEMENT THERAPY IMPACTS ON AGE OF FIRST PRESENTATION AND QUALITY OF LIFE IN PATIENTS WITH VASOSPASM AND CORONARY MICROVASCULAR DYSFUNCTION.

Background: Epicardial vasospasm and coronary microvascular dysfunction (CMD) are two vasomotor etiologies of myocardial infarction with no obstructive coronary arteries and ischemia with no obstructive coronary arteries [(M)INOCA]. Endothelial dysfunction is implicated in the pathology of both conditions. Estrogen plays a significant role in healthy endothelial function by mediating endothelial-dependent vasodilation. Use of hormone replacement therapy (HRT) has been shown to help alleviate menopausal symptoms, improving quality of life (QoL) metrics in the perimenopausal transition. However, this observation has not been well-studied in a vasomotor (M)INOCA context. We hypothesize that longer duration of HRT use is associated with higher QoL scores and later age of presentation of these vasomotor syndromes.

METHODS AND RESULTS: This study investigated female patients with vasomotor (M)INOCA enrolled in the Leslie Diamond Women’s Heart Health Clinic (WHC) Registry since 2016 in Vancouver, Canada. QoL was measured at first WHC visit using the Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ), and was compared to self-reported length of HRT use as of the first WHC visit and earliest age of cardiac testing (myocardial perfusion imaging test, echocardiogram, computed tomography coronary angiogram, or coronary angiogram), which was used as a proxy for age of first presentation. Pearson’s correlation test (r) was used to compared length of HRT use and age of presentation. Subgroup analysis using Welch’s t-test was conducted by age of onset as a binary group of ≤55 or >55 years.

A total of 74 women with CMD (n=56, 76%), vasospasm (n=17, 23%), or both (n=1, 1%) used HRT with a mean age of 60 years (±8.7) at earliest cardiac testing and 84% self-identified as White. Age of earliest presentation was not significantly correlated with number of years on HRT when stratified by menopause group (Figure 1). There was a modest positive correlation observed in the post menopause group (r=0.30, p=0.088), followed by surgical with ovaries retained (r=0.27, p=0.28), then pre/peri (r=0.15, p=0.78) and surgical with ovaries removed (r=0.04, p=0.87). Patients over 55 years old (n=47, mean score 66.4) at their first presentation had significantly (p = 0.0041) higher QLESQ scores than patients 55 and under (n=23, mean score 51.04), regardless of length of HRT use (t (37) = -3.1). (Figure 2)

Conclusion: Younger-onset participants had lower QoL scores and did not receive benefits from longer durations of HRT. Further research is needed to evaluate interventions that benefit this population with vasomotor (M)INOCA.