Women With Less Plaque Still Face High Heart Risk, Study Warns

Women can face the same risk of heart attack and serious chest pain as men, even when they have less plaque in their arteries. A new study shows risk in women starts rising earlier, at lower plaque levels. This means many women may be told they are “low risk” when they are not. Doctors say chest pain in women should never be ignored.

What The New Study Actually Found

The research was published in Circulation: Cardiovascular Imaging. It looked at more than 4,200 patients from the PROMISE trial. These were people with chest pain but no known history of coronary artery disease.

Researchers used coronary CT angiography to measure plaque volume and plaque burden. Instead of just checking for blocked arteries, they measured how much plaque was present in total. Patients were followed for about 26 months. Doctors tracked major events like nonfatal heart attack, hospital stay for chest pain, or death from any cause.

Women had less overall plaque than men. Still, their risk of serious events was similar. Even more concerning, women’s risk began rising at about 20 percent plaque burden. In men, risk increased later, around 28 percent. That gap matters.

Why Lower Plaque Does Not Mean Lower Risk

For years, heart risk models were built mostly using data from men. So when women showed less plaque, they were often labeled lower risk. But this study challenges that idea.

Jan Brendel from Massachusetts General Hospital explained that women may experience heart events even without large artery blockages. Risk in women rose sharply at lower plaque levels, then leveled off. In men, risk increased more slowly and gradually.

There was overlap between men and women at higher plaque levels. So it is not black and white. Still, the pattern shows something important. Women cannot be reassured only because plaque looks mild.

The Problem With Current Guidelines

Some experts believe current practice guidelines are outdated. Many still focus on finding obstructive coronary artery disease. But nonobstructive disease can also lead to heart attacks. In fact, it may be more common than once thought.

Women tend to have more nonobstructive disease compared to men of similar age and risk. That means they may be sent home without proper treatment. Symptoms like chest tightness, pressure, jaw pain, or shortness of breath sometimes get dismissed. That delay can be dangerous.

Sadiya Khan from Northwestern University stressed that symptoms should not be brushed aside. If a woman reports chest pain, she needs proper evaluation. Not assumptions.

What This Means For Women Today

Heart disease remains the leading cause of death in women. That fact alone should change how we think. If plaque testing shows even low-to-moderate buildup, doctors may need to look closer.

Quantitative plaque measurement could help personalize risk assessment. Instead of a simple yes-or-no blockage result, doctors can measure total plaque burden. This gives a fuller picture.

The American Heart Association’s newer PREVENT risk score may also improve prediction. It reflects more modern data on how plaque connects with outcomes. Medicine evolves, slowly sometimes, but it moves.

For women, the key message is simple. Do not ignore chest pain. Do not assume you are safe because a scan shows “minimal” plaque. Ask questions. Get clarity. Early prevention saves lives, even when numbers seem small.