Women with less arterial plaque have heart attacks at the same rate as men |
Your coronary artery scan may come back showing a modest level plaque and no immediate cause for alarm. For many women, this is where the conversation ends, but a new study of nearly 4,300 patients found that women experience major adverse cardiac events (from which they are more than twice as likely to die) at the same rate as men, despite consistently lower plaque readings.
The problem is that what counts as a “normal” scan may differ for men and women.
Women’s coronary arteries are smaller, so even modest plaque deposits take up a larger share of the vessel. When researchers measured plaque as a percentage of arterial cross-sectional area rather than raw volume, the gap in plaque levels between the sexes narrowed, but the risk of heart attack did not. Women’s cardiovascular events began climbing above a plaque burden of around 20%, while the risk threshold for men is nearer 28%.
“Less plaque does not necessarily mean low risk in women,” Kevin Shah, MD, a board certified cardiologist at MemorialCare Heart & Vascular Institute, told Medical News Today. “This study reinforces that plaque biology and distribution matter — not just total quantity.”
So, uniform plaque thresholds used in clinical practice may be quietly underestimating risk in women. Lead author of this new study, Jan Brendel, MD, noted that the findings don’t yet justify formal sex-specific cutoffs. Instead, they support the need for more research into the development of age- and sex-based percentiles similar to those already used in coronary calcium scoring.
To learn more about the questions to ask at your next heart health check-up, jump to “Women at risk of major cardiac events despite lower plaque burden.”
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