Women Face Higher Heart Disease Risk with Lower Plaque Levels, Study Finds

New research indicates that women may experience major cardiovascular events with lower levels of plaque buildup in their arteries compared to men, highlighting the need for tailored heart disease prevention strategies. Heart disease remains the leading cause of death in America, making prevention a critical focus for all, but particularly for women.

Study Details and Findings

A study published in the journal Circulation: Cardiovascular Imaging analyzed data from nearly 4,300 individuals with no prior coronary artery disease who presented with chest pain. Researchers utilized computed tomography angiography (CCTA) to measure total plaque volume and total plaque burden (TPB) – the amount of plaque relative to the size of the blood vessel. Plaque, composed of cholesterol, fat, calcium, and other substances, restricts blood flow and increases the risk of heart attack and stroke. Circulation: Cardiovascular Imaging

The study revealed that women had lower amounts of plaque and less plaque with high-risk characteristics than men, yet experienced similar rates of major adverse cardiovascular events (MACE) over a 26-month period. Specifically, cardiovascular risk in women increased significantly when plaque burden reached 20%, whereas in men, the risk didn’t rise until plaque burden reached 28%.

Researchers concluded that a “sex-specific interpretation” of plaque measurements is necessary for “timely intervention” in women.

Why the Discrepancy?

The exact reasons for this difference remain unclear. Although the study identified the disparity, it didn’t pinpoint the underlying cause. Cardiologists suggest several factors may contribute.

“The theory is that females, on average, are smaller than males, and their heart sizes are smaller,” explains Kevin Shah, M.D., cardiologist and program director of heart failure outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center. “But the actual metric with plaque volume tries to adjust for the size of the blood vessels.”

Navjot Sobti, M.D., interventional cardiologist and women’s heart health specialist at Northwell’s Northern Westchester Hospital and Katz Institute for Women’s Health, points out that heart disease often manifests differently in women. “women have been historically underrepresented in cardiovascular research,” Dr. Sobti notes. “Many risk thresholds and imaging cutoffs were developed using male populations and focus on finding large artery blockages a.k.a. ‘obstructive disease,’ but women are more likely to have non-obstructive disease and types of heart attacks that don’t show large blockages on heart imaging.” Medical News Today

Women may develop heart attacks due to conditions like coronary artery spasm, spontaneous coronary artery tear or dissection (SCAD), or problems in the heart’s slight blood vessels – conditions often missed by traditional heart disease risk models. This can lead to serious cardiac events even with lower levels of visible plaque.

Lowering Your Heart Attack Risk

The American Heart Association (AHA) recommends following “Life’s Essential Eight” to improve and maintain cardiovascular health. American Heart Association These include:

• Eat better: Adopt a heart-healthy diet.
• Be more active: Engage in regular physical activity.
• Quit tobacco: Avoid all forms of tobacco and nicotine.
• Manage weight: Maintain a healthy weight.
• Get healthy sleep: Prioritize adequate sleep.
• Control cholesterol: Manage cholesterol levels.
• Manage blood sugar: Control blood sugar levels.
• Manage blood pressure: Keep blood pressure within a healthy range.

For women, even mild coronary plaque may warrant earlier and more aggressive prevention methods, such as statins, blood pressure control, and lifestyle interventions, along with proactive screening like coronary calcium scoring.

The Bottom Line

These findings underscore the importance of sex-specific risk assessment in heart disease prevention. More research is needed, but experts agree that recognizing the differences in how heart disease presents in men and women is crucial for improving outcomes. Consult with your physician for personalized recommendations.