DALLAS, Feb. 23, 2026 — Women face a heightened risk of heart attacks and chest pain at lower levels of artery plaque than men, according to a groundbreaking study published today in Circulation: Cardiovascular Imaging. This research challenges the conventional understanding that fewer artery-clogging plaques equate to a lower risk of cardiovascular events.
The study, which analyzed health data from over 4,200 adults, reveals that despite having less plaque, women are not shielded from heart disease. The findings indicate that women’s risk of heart attack and chest pain increases more rapidly, particularly after menopause, compared to men.
Study Insights and Key Findings
Conducted with participants who had stable chest pain and no prior history of coronary artery disease, the study involved diagnostic evaluations using coronary computed tomography angiography. Participants were monitored for approximately two years to assess the impact of plaque levels on heart health.
- 55% of women had plaque in their coronary arteries compared to 75% of men.
- Women had a median plaque volume of 78 mm3 versus 156 mm3 in men.
- Despite less plaque, women were just as likely to experience major cardiovascular events as men (2.3% of women vs. 3.4% of men).
- Women’s risk began to rise at 20% plaque burden, while men’s risk started at 28%.
Dr. Borek Foldyna, the study’s senior author and an assistant professor in radiology at Harvard Medical School, emphasized the significance of these findings. “Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes,” he stated. “Because women have smaller coronary arteries, a small amount of plaque can have a bigger impact. Moderate increases in plaque burden appear to have disproportionate risk in women, suggesting that standard definitions of high risk may underestimate risk in women.”
Implications for Women’s Cardiovascular Health
The research highlights the need for gender-specific approaches in understanding and treating cardiovascular disease. Dr. Stacey E. Rosen, volunteer president of the American Heart Association, stressed the importance of recognizing the biological differences in how heart disease manifests in men and women. “There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men, and these differences can influence everything from risk factors to symptoms to treatment response,” she noted.
According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, cardiovascular disease was the cause of death in 433,254 females of all ages, representing 47.3% of deaths from cardiovascular disease. This underscores the critical need for tailored strategies to address the unique risks faced by women.
Background and Study Design
The patients involved in this study were part of the PROMISE trial, a large-scale investigation of adults with stable chest pain treated at 193 clinical sites across the U.S. and Canada. The trial’s participants, including 4,267 adults with an average age of 60 and 51% women, were followed for about two years.
Dr. Jan Brendel, the study’s lead author and a research fellow at Massachusetts General Hospital and Harvard Medical School, played a pivotal role in analyzing the data. The study’s findings contribute to a growing body of research aimed at reducing the cardiovascular disease burden among women.
Looking Ahead
This study’s revelations call for a re-evaluation of how cardiovascular risks are assessed and managed in women. As research continues to uncover the nuances of heart disease across genders, healthcare providers may need to adjust their strategies to better cater to women’s unique health profiles.
The findings also highlight the importance of continued research and awareness to bridge the gap in understanding gender differences in cardiovascular health. Future studies could further explore how these insights can be translated into clinical practice to improve outcomes for women at risk of heart disease.
