Women Face Heart Attack Risk at Lower Plaque Levels Than Men

Women develop heart attack risk at lower artery-clogging plaque levels than men, despite typically having less plaque, according to a new Harvard Medical School-led study reported by PTI. Published in Circulation: Cardiovascular Imaging, the research analysed over 4,200 chest pain outpatients without prior coronary artery disease history, finding women (55% with plaque vs. 75% men) had lower volumes (median 78 mm³ vs. 156 mm³) but similar major adverse cardiovascular event rates (2.3% vs. 3.4%).
Risk emerged at 20% total plaque burden in women versus 28% in men, rising more steeply for women due to smaller coronary arteries amplifying plaque impact, senior author Borek Foldyna noted. “Women are not ‘protected’ from coronary events despite lower plaque volumes,” Foldyna said, urging sex-specific risk thresholds as standard metrics underestimate women’s vulnerability.
The PROMISE trial data showed women’s risk escalated disproportionately with moderate plaque increases, challenging uniform guidelines. Post-menopausal acceleration was implied, aligning with prior findings on plaque progression differences.
Clinicians should incorporate sex-adjusted plaque metrics for tailored prevention, researchers recommend.