DALLAS, Feb. 23, 2026 — A groundbreaking study published today in Circulation: Cardiovascular Imaging reveals that women are at risk of heart attacks and other cardiovascular events at lower levels of artery-clogging plaque than men. This research, involving over 4,200 adults, challenges the conventional understanding that women are inherently protected from heart disease due to typically having less arterial plaque.
Despite having a lower prevalence of artery plaque, women experience cardiovascular risks that escalate more rapidly, particularly post-menopause. This study’s findings underscore the need to reassess how heart disease risk is evaluated in women, highlighting that they are just as likely as men to suffer from severe outcomes like heart attacks and hospitalization for chest pain.
Study Insights and Key Findings
The research analyzed health data from over 4,200 adults, more than half of whom were women, to assess the impact of plaque quantity on the risk of major heart conditions. Participants, who had stable chest pain and no prior coronary artery disease, underwent coronary computed tomography angiography and were monitored for approximately two years.
- 55% of women had plaque in their coronary arteries compared to 75% of men.
- Women had a median plaque volume of 78 mm3, significantly lower than the 156 mm3 in men.
- Despite less plaque, 2.3% of women experienced severe cardiovascular events compared to 3.4% of men.
- Women’s risk began to rise at 20% plaque burden, while men’s risk started at 28%.
Dr. Borek Foldyna, senior author and assistant professor in radiology at Harvard Medical School, emphasized, “Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes. Because women have smaller coronary arteries, a small amount of plaque can have a bigger impact.”
Implications for Women’s Cardiovascular Health
The study highlights the urgent need to recognize the distinct ways cardiovascular disease affects men and women. Dr. Stacey E. Rosen, volunteer president of the American Heart Association, stated, “There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men. These differences can influence everything from risk factors to symptoms to treatment response.”
According to the American Heart Association’s 2026 statistics, cardiovascular disease was responsible for 433,254 female deaths, accounting for 47.3% of deaths from cardiovascular disease. These numbers underline the critical importance of tailored research and healthcare strategies that address gender-specific health challenges.
Study Design and Broader Context
The research is a subset of the PROMISE trial, which involved adults with stable chest pain treated at 193 clinical sites across the U.S. and Canada. Participants, with an average age of 60 and 51% being women, were followed for about two years. Dr. Jan Brendel, the study’s lead author and research fellow at Massachusetts General Hospital and Harvard Medical School, spearheaded the analysis.
This development follows a growing body of evidence calling for more gender-specific research in cardiovascular health. Historically, heart disease research has predominantly focused on male subjects, often overlooking the nuanced differences in how women experience and respond to heart disease.
Looking Ahead: Addressing the Gender Gap
The findings from this study could reshape how cardiovascular risk is assessed and managed in women. By recognizing the unique risks women face, healthcare providers can develop more effective prevention and treatment strategies. The move represents a significant step toward reducing the cardiovascular disease burden among women, aligning with broader efforts to address health disparities.
As research continues to evolve, it is crucial for both the medical community and public health policymakers to integrate these insights into practice, ensuring that women receive the most accurate risk assessments and appropriate care. The study’s revelations are a call to action for further research and a reevaluation of existing guidelines to better serve women’s health needs.
