A study published today in Circulation: Cardiovascular Imaging, an American Heart Association journal, found that less artery-clogging plaque in women's arteries does not shield them from heart disease compared to men. The research, involving more than 4,200 adults, indicates that women face increased heart risk at lower plaque levels than men, with risk rising more sharply for women as plaque burden increases.
While heart disease remains the leading cause of illness and death in the U.S. and worldwide, according to the American Heart Association's 2026 Heart Disease and Stroke Statistics, women typically have a lower prevalence of artery plaque than men. This study evaluated health data for 4,267 adults (51% women) with stable chest pain and no prior history of coronary artery disease. Participants underwent coronary computed tomography angiography and were followed for about two years.
Key findings showed that fewer women had plaque in their coronary arteries than men (55% vs. 75%), and women had a lower volume of plaque (median 78 mm³ vs. 156 mm³). Despite this, women were just as likely as men to die from any cause, have a non-fatal heart attack, or be hospitalized for chest pain (2.3% of women vs. 3.4% of men). Additionally, women's risk began to rise at 20% plaque burden, compared to 28% for men. With increasing plaque levels, risk rose more sharply for women.
“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 in Boston. “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.”
Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and executive director of the Katz Institute for Women’s Health at Northwell Health, commented, “These findings are another important example of why it is imperative to recognize that cardiovascular disease can impact men and women so differently. 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.”
According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, cardiovascular disease was the cause of death in 433,254 females of all ages, representing 47.3% of deaths from cardiovascular disease. The study, led by Dr. Jan Brendel, M.D., research fellow at Massachusetts General Hospital and Harvard Medical School, was a subset of the PROMISE trial, which included adults with stable chest pain and no prior coronary artery disease, treated at 193 clinical sites in the U.S. and Canada.
