Women Face Heart Risks at Lower Plaque Levels
New research reveals women may experience heart attacks at lower levels of artery-clogging plaque compared to men, challenging assumptions about cardiovascular risk assessment. Multiple studies confirm the same amount of coronary plaque is associated with greater risk in women, potentially leading to underdiagnosis and undertreatment. The findings suggest standard diagnostic thresholds may fail to capture women at risk.
- A recent study in the journal *Circulation* analyzed data from over 4,200 individuals and found that while only 55% of women had plaque in their coronary arteries compared to 75% of men, they were just as likely to suffer a major cardiac event. - For women, the risk of a major adverse cardiovascular event, such as a heart attack or hospitalization for chest pain, begins to increase when the total plaque burden reaches 20%, whereas for men, the risk starts to rise at a 28% plaque burden. - The study's senior author, Dr. Borek Foldyna, noted that because women have smaller coronary arteries, even a small amount of plaque can have a more significant impact. - Historically, women have been underrepresented in cardiovascular research, making up less than 30% of participants in most clinical trials, which has led to gaps in understanding how heart disease presents in women. - Women experiencing a heart attack are less likely to report chest pain and more commonly present with "atypical" symptoms like back, jaw, or neck pain, shortness of breath, indigestion, and nausea, which can lead to misdiagnosis. - Risk factors such as smoking and diabetes have been shown to disproportionately increase the risk of obstructive coronary artery disease in women compared to men. - Some cardiovascular risk calculators do not incorporate female-specific risk factors like early menopause, polycystic ovary syndrome, or adverse pregnancy outcomes, potentially leading to an underestimation of risk. - The American Heart Association has recognized the need for different risk assessment strategies and has started to incorporate reproductive history, such as pre-eclampsia, as an indicator of underlying inflammatory processes that could signal future cardiovascular risk.
