Study Reports Women Face Cardiovascular Risk at Lower Coronary Plaque Burden

Investigators reporting a PROMISE trial analysis described sex differences in how coronary plaque burden related to subsequent events.

Women were reported to have lower measured plaque yet similar outcome rates, and event risk was described as increasing at lower plaque levels in women than in men. The report frames these findings as a sex-differentiated relationship between plaque burden and risk in a stable chest pain population.

The analysis included health data from more than 4,200 adults with stable chest pain and no prior history of coronary artery disease who underwent coronary computed tomography angiography and were followed for about two years. Outcomes were reported as a composite of death from any cause, nonfatal myocardial infarction, or hospitalization for chest pain; the summary reported composite event rates of about 2.3% in women and 3.4% in men.

For baseline imaging findings, the abstract reported that fewer women had detectable coronary artery plaque than men, and that plaque volume was lower in women. Plaque was reported as present in 55% of women versus 75% of men, and the reported median plaque volume was 78 mm3 in women versus 156 mm3 in men. These differences provided the backdrop for the report’s central question: whether a given plaque burden carried the same risk signal across sexes.

The investigators also reported sex-specific plaque-burden levels at which risk began to rise, describing an earlier inflection in women and a later one in men. For total plaque burden, the summary stated that women’s risk began to rise at around 20% plaque burden, whereas men’s risk started at around 28%, and it described risk as increasing more sharply with higher plaque levels in women than in men.

In interpreting these patterns, the authors suggest that smaller coronary artery size in women could mean modest increases in plaque have a disproportionate impact compared with men. Overall, the report characterizes a plaque–event relationship in which lower measured plaque in women did not correspond to lower observed event occurrence.

Key Takeaways:

• Lower measured coronary plaque prevalence and volume in women versus men was reported in this cohort.
• Similar composite outcome rates by sex were reported despite those plaque differences.
• The report described risk beginning to rise at a lower total plaque-burden level in women than in men, alongside an author-attributed suggestion that smaller coronary arteries might contribute to the observed pattern.