Women's Heart Disease Risk Rises At Lower Plaque Levels

You've had your heart checked. Your doctor says everything looks "normal." You leave the appointment feeling reassured. But here's the thing: what if the benchmarks used to evaluate your heart weren't designed with your body in mind?

New research suggests that's exactly what's been happening. A study published in Circulation: Cardiovascular Imaging found that women's risk of heart disease starts climbing at significantly lower levels of arterial plaque than men's. In other words, the thresholds we've been using to flag heart problems may be missing women who are actually at risk.

The study, known as the PROMISE trial, analyzed data from more than 4,200 adults with chest pain or shortness of breath. More than half of the participants were women. Researchers used CT angiography to measure plaque buildup in the coronary arteries and then tracked outcomes over time.

It was found that women had less plaque overall. Only 55% of women had any plaque at all, compared to 75% of men. And when plaque was present, women's median volume was about half that of men's: 78 cubic millimeters versus 156 cubic millimeters.

You'd expect that to mean better outcomes for women, right? Not quite.

Despite having less plaque, women experienced similar rates of major cardiac events. About 2.3% of women died, had a heart attack, or were hospitalized for unstable chest pain, compared to 3.4% of men. The gap was much smaller than the plaque difference would suggest.

Heart disease is the leading cause of death for women in the United States. Yet for decades, most cardiovascular research focused primarily on men. The results found that screening guidelines, risk calculators, and "normal" thresholds may not account for how heart disease shows up differently in women.

This study adds to a growing body of evidence that women's hearts don't follow the same playbook as men's. If a woman's risk starts rising at 20% plaque burden but her doctor is using 28% as the cutoff, she could be told she's fine when she's actually not.

It's like using a men's shoe size chart to fit women's shoes. The numbers might technically work, but the fit is off.

You don't need to overhaul your life or demand a battery of tests. But you can take a few smart steps to make sure your heart health is being evaluated accurately.

Ask about CT angiography. If you have risk factors for heart disease (high blood pressure, high cholesterol, diabetes, family history, or smoking), ask your doctor whether a coronary CT angiography might be appropriate. It's the imaging technique used in this study and can detect plaque before it causes symptoms.

Bring up sex-specific thresholds. At your next appointment, ask: "Are the benchmarks you're using based on data that includes women? Should we be looking at my results differently?" It's a simple question that can open an important conversation.

Know your numbers. Stay on top of the basics: blood pressure, LDL and HDL cholesterol, triglycerides, and blood sugar. These are still your best early warning signs, and they're easy to track.

Women's hearts may need different screening thresholds than men's. This new research from the PROMISE trial shows that women's cardiovascular risk begins rising at lower levels of plaque, which means current guidelines could be missing women who are actually at risk.