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

A study published in Circulation: Cardiovascular Imaging found that women face increased risk of heart attack and chest pain at lower levels of artery plaque than men, despite typically having less plaque overall. The research analyzed data from 4,267 adults with stable chest pain and no prior coronary artery disease history, revealing that women’s cardiovascular risk begins rising at 20% plaque burden compared to 28% for men.

While 55% of women had plaque in their coronary arteries versus 75% of men, and women had a median plaque volume of 78 mm³ compared to 156 mm³ in men, women were just as likely as men to experience major cardiac events. During approximately two years of follow-up, 2.3% of women versus 3.4% of men died from any cause, had non-fatal heart attacks, or were hospitalized for chest pain.

‘Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes,’ said senior author Borek Foldyna, M.D., Ph.D., an assistant professor in radiology at Harvard Medical School. ‘Because women have smaller coronary arteries, a small amount of plaque can have a bigger impact. Moderate increases in plaque burden appear to have disproportionate risk in women, suggesting that standard definitions of high risk may underestimate risk in women.’

The study participants were part of the PROMISE trial, which included adults treated at 193 clinical sites in the U.S. and Canada. All participants underwent diagnostic evaluation via coronary computed tomography angiography and were followed for about two years. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, cardiovascular disease caused 433,254 female deaths across all ages, representing 47.3% of cardiovascular disease deaths.

‘These findings are another important example of why it is imperative to recognize that cardiovascular disease can impact men and women so differently,’ said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association. ‘There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men, and these differences can influence everything from risk factors to symptoms to treatment response.’

The research highlights that risk increased more sharply for women than for men as plaque levels rose, particularly after menopause. The American Heart Association provides additional health information about atherosclerosis and heart attack symptoms in women through their educational resources. Studies published in the Association’s scientific journals undergo peer review, and the organization maintains strict policies to prevent corporate donations from influencing scientific content.

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