Researchers from Mass General Brigham have found notable differences in how coronary plaque burden relates to cardiovascular event risk between women and men. The study, published in Circulation, analyzed data from nearly 4,300 stable outpatients who experienced chest pain but had no prior diagnosis of coronary artery disease (CAD).
The research team used cardiac computed tomography angiography (CCTA) images from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), which included participants from 193 sites across North America. They measured total plaque volume and total plaque burden—the amount of plaque relative to vessel size—and identified different types of plaques, such as stable plaques with more calcium and high-risk plaques with higher fat content.
Over a median follow-up period of 26 months, women showed similar rates of major adverse cardiovascular events (MACE)—defined as death, heart attack, or hospitalization for chest pain—compared to men. While women generally had smaller overall plaque volumes than men, their vessel size-adjusted total plaque burden was similar.
Importantly, the threshold at which risk for MACE increased was lower in women—about 20% TPB compared to approximately 28% in men. In addition, women's risk rose more sharply at lower levels of plaque burden than men's risk did; men required larger amounts of plaque before experiencing a comparable increase in risk. These trends remained even after accounting for traditional cardiovascular risk factors and other imaging findings like the presence of high-risk plaques.
The study suggests that including sex as a factor when interpreting coronary plaque measurements could improve individualized approaches to assessing cardiac risk.
