Women Face Heart Risk at Lower Plaque Levels
New research shows that women are at risk for heart attacks at lower levels of coronary plaque compared to men. The findings suggest that traditional screening and intervention thresholds may not adequately protect women and highlight the importance of sex-specific guidelines in cardiac care.
- The study analyzed data from nearly 4,300 patients and found that the risk of major adverse cardiovascular events (MACE), such as death or heart attack, emerged at a lower total plaque burden for women (approximately 20%) compared to men (approximately 28%). - Historically, much of the foundational research in cardiology has predominantly focused on male subjects, leading to a knowledge gap in how cardiovascular diseases manifest and progress in women. This has resulted in clinical guidelines that may not be optimal for female patients. - For decades, women have been significantly underrepresented in cardiovascular clinical trials. Reasons for this include the exclusion of women of childbearing age, a lack of awareness among both patients and investigators, and logistical barriers like childcare. - Coronary artery calcium (CAC) scoring is a common, non-invasive test that measures calcified plaque in the heart's arteries. Current guidelines often recommend considering statin therapy for a score between 100 to 400 and more aggressive intervention for scores above 400, but these are not typically adjusted for sex. - Diabetes, hypertension, smoking, and obesity are more potent risk factors for heart disease in women than in men. Women also have unique risk factors such as those related to pregnancy (like pre-eclampsia) and menopause. - Women are more likely than men to experience atypical heart attack symptoms, which can lead to delays in seeking care and diagnosis. These can include indigestion, shortness of breath, and back pain, sometimes without the classic chest discomfort. - Anatomically, women tend to have smaller hearts and narrower blood vessels compared to men. Plaque in women is also more likely to develop in the heart's smallest blood vessels, known as the microvasculature. - On average, a first heart attack occurs in men at age 65, while for women, the average age is 72. However, since 1984, more women than men have died from heart disease each year, partly because women generally live longer.
