Full Breakdown
Women's Cardiac Risk Emerges at Lower Coronary Plaque Burden
2/24/2026, 5:43:20 AM
Key Findings on Coronary Artery Disease in Women
Recent research published in *Circulation: Cardiovascular Imaging* reveals that women face a heightened risk of major adverse cardiovascular events (MACE) at lower levels of coronary artery plaque compared to men. The study, conducted by investigators from Mass General Brigham and Harvard Medical School, analyzed data from 4,267 stable outpatients with chest pain and no prior diagnosis of coronary artery disease (CAD). The findings indicate that while women typically have smaller total plaque volumes—averaging 78 mm³ compared to 156 mm³ in men—this does not correlate with a lower risk of cardiovascular events.
The study found that women's risk of MACE began to rise at a total plaque burden (TPB) of approximately 20%, whereas men’s risk increased at a TPB of about 28%. Notably, 55% of women had coronary artery plaque compared to 75% of men. Despite these differences, the rates of MACE were similar between the sexes after a median follow-up of 26 months, with 2.3% of women and 3.4% of men experiencing events such as heart attacks or hospitalization for chest pain.
Implications for Cardiac Risk Assessment
The research underscores the necessity of incorporating sex and age into the evaluation of coronary plaque metrics. Lead author Jan Brendel emphasized that applying uniform thresholds across sexes may underestimate the risk for women. The study suggests that moderate increases in plaque burden can have a disproportionately higher impact on women due to their smaller coronary arteries, which may lead to earlier and steeper increases in cardiovascular risk.
Senior author Borek Foldyna noted, “Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes.” This highlights a critical need for tailored approaches to cardiac risk stratification that consider biological differences between men and women.
Criticism and Opposition
Some experts argue that the traditional metrics used to assess cardiovascular risk may not adequately reflect the complexities of women's health. Stacey E. Rosen, president of the American Heart Association, stated, “There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men.” This perspective advocates for a more nuanced understanding of cardiovascular disease that accounts for these differences.
Verbatim Quotes
- “Our findings suggest that applying uniform thresholds across sexes to determine whether patients’ plaque measures put them at high risk for MACE may underestimate risk in women,” — Jan Brendel, Lead Author, Mass General Brigham
- “Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes,” — Borek Foldyna, MD, PhD, Harvard Medical School
- “‘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.” — Stacey E. Rosen, MD, FAHA, American Heart Association
Conclusion
The study's results advocate for a shift in how cardiovascular risk is assessed, particularly for women. By recognizing the distinct risk profiles associated with lower plaque burdens, healthcare providers can better tailor prevention and treatment strategies for women, ultimately improving outcomes in this population.
