Although heart disease is the leading cause of death in both men and women, the way it develops and manifests can vary significantly between the sexes.
According to a US study published in Circulation: Cardiovascular Imaging, women generally have less artery-clogging plaque than men, yet their risk of chest pain, heart attack and death is similar.
To better understand how plaque burden affects heart disease risk in men and women, researchers analysed data from 4,267 adults treated for stable chest pain but who had no prior history of coronary artery disease. The average age of the participants was 60, and 52 per cent were women.
Using coronary computed tomography angiography, investigators measured plaque buildup in the coronary arteries. Participants were followed for approximately two years.
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The results showed that only 55 per cent of women had plaque in their coronary arteries, compared with 75 per cent of men. Women also had significantly lower plaque in their arteries—a median of 78 cubic millimetres versus 156 cubic millimetres in men.
Despite having less plaque, women were only marginally less likely as men to experience serious outcomes, including death from any cause, heart attack, or hospitalisation for chest pain (2.3 per cent of women versus 3.4 per cent of men).
Notably, women faced elevated heart risks at lower levels of plaque than men. Risk for women began to rise at a 20 per cent plaque burden, compared with 28 per cent in men. As plaque levels increased, risk escalated more sharply for women.
“Our findings underscore that women are not 'protected' from coronary events despite having lower plaque volumes,” the study’s senior author said.
"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."