Here’s a startling fact: women are at higher risk of heart attacks even with less artery-clogging plaque than men. But here’s where it gets controversial—this finding flips the script on what we thought we knew about heart disease. According to a groundbreaking study published in Circulation: Cardiovascular Imaging, an American Heart Association journal, having less plaque doesn’t shield women from cardiovascular events as effectively as it might for men. This raises a critical question: Are traditional risk assessments underestimating women’s heart health risks?
Heart disease remains the leading cause of illness and death globally, yet women typically have less plaque buildup in their arteries compared to men. So, why does this matter? The study, which analyzed data from over 4,200 adults (more than half of whom were women), revealed that women’s risk of heart attack and chest pain escalates more rapidly—especially after menopause—even with lower plaque levels. And this is the part most people miss: women’s risk begins to rise at a 20% plaque burden, while men’s risk doesn’t start climbing until they reach 28%.
Let’s break it down further. Despite having less plaque, women were just as likely as men to experience fatal or non-fatal heart attacks or be hospitalized for chest pain. For instance, 2.3% of women faced these outcomes compared to 3.4% of men—a smaller gap than you might expect. Senior author Borek Foldyna, M.D., Ph.D., highlights that women’s smaller coronary arteries mean even a small amount of plaque can have a disproportionately larger impact. This suggests that standard definitions of high risk may not adequately account for women’s unique vulnerabilities.
Here’s the bold part: Could our current approach to heart disease be overlooking critical gender-based differences? Stacey E. Rosen, M.D., FAHA, emphasizes the urgent need to recognize how cardiovascular disease manifests differently in women, from risk factors to symptoms and treatment responses. With cardiovascular disease claiming the lives of 433,254 females in 2026 alone, according to the American Heart Association, this isn’t just an academic debate—it’s a matter of life and death.
The study, led by Dr. Jan Brendel, M.D., drew from the PROMISE trial, which followed adults with stable chest pain and no prior history of coronary artery disease. Participants underwent coronary computed tomography angiography and were monitored for approximately two years. The findings underscore the importance of tailoring heart health assessments to account for biological differences between men and women.
Now, here’s a thought-provoking question for you: Should we rethink how we define ‘high risk’ for heart disease in women? Share your thoughts in the comments—let’s spark a conversation that could save lives.
