Study Reveals Women Face Heart Attack Risk at Lower Plaque Levels Than Men

A study published in Circulation: Cardiovascular Imaging found that women face heart attack and chest pain risk at lower levels of artery-clogging plaque than men, despite typically having less plaque overall. The research, involving more than 4,200 adults, revealed that while fewer women had plaque in their coronary arteries (55% of women vs. 75% of men) and women had lower plaque volume (median 78 mm³ vs. 156 mm³ in men), women were just as likely as men to experience major cardiovascular events.

The study's key finding indicates that women's risk begins to rise at 20% plaque burden, compared to 28% for men, with risk increasing more sharply for women as plaque levels grow. Senior author Borek Foldyna, M.D., Ph.D., explained that because women have smaller coronary arteries, "a small amount of plaque can have a bigger impact" and that "moderate increases in plaque burden appear to have disproportionate risk in women." This suggests current definitions of high risk may underestimate danger for women.

Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, emphasized the importance of recognizing biological differences in cardiovascular disease manifestation between genders. "There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men," Rosen stated, noting these differences influence everything from risk factors to symptoms to treatment response.

The research analyzed data from the PROMISE trial, which followed adults with stable chest pain and no prior coronary artery disease history for approximately two years. Participants underwent diagnostic evaluation via coronary computed tomography angiography, with findings showing 2.3% of women versus 3.4% of men experienced death from any cause, non-fatal heart attack, or hospitalization for chest pain during the study period.

According to the American Heart Association's 2026 Heart Disease and Stroke Statistics, cardiovascular disease remains the leading cause of death worldwide, responsible for 433,254 female deaths in the U.S. alone. The study's findings highlight the need for gender-specific approaches to cardiovascular risk assessment and management, particularly as risk appears to increase more rapidly in women, especially after menopause.

Additional resources about cardiovascular health include information on atherosclerosis and heart attack symptoms in women. The research contributes to growing evidence that cardiovascular disease manifests differently in women and men, with implications for screening, diagnosis, and treatment approaches that account for these biological differences.