THURSDAY, Feb. 26, 2026 (HealthDay News) -- Major adverse cardiovascular events emerge at a lower coronary plaque burden (PB) in women than men, according to a study published online Feb. 23 in Circulation.
Jan M. Brendel, M.D., from Massachusetts General Hospital in Boston, and colleagues compared cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain. The analysis included data from 4,267 participants from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain, with adverse events monitored for a median 26 months.
The researchers found that plaque was less frequent in women (55 versus 75 percent). While lower total plaque volume was seen in women, women and men had similar total plaque burden (PB) and incident major adverse cardiovascular events (2.3 versus 3.4 percent). In women, major adverse cardiovascular event risk became elevated at lower PB than in men. For total PB, the hazard ratio crossed 1.0 at 20 percent in women versus 28 percent in men, reaching a hazard ratio of 1.5 at 32 percent in women versus 42 percent in men. A similar pattern was seen for noncalcified PB, crossing a hazard ratio of 1.0 at 7 percent in women versus 9 percent in men and reaching a hazard ratio of 1.5 at 13 percent in women versus 20 percent in men. Findings persisted when adjusting for atherosclerotic cardiovascular disease risk score.
"Our findings underscore that women are not 'protected' from coronary events despite having lower plaque volumes," senior author Borek Foldyna, M.D., Ph.D., from Harvard University in Boston, said in a statement. "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."
Several authors disclosed ties to the pharmaceutical and medical technology industries.