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Heart disease remains the leading cause of death for both men and women in the United States, but emerging research suggests a critical difference in how the condition manifests and progresses in women. A novel study published in Circulation: Cardiovascular Imaging reveals that women may experience major cardiovascular events – including heart attacks – with surprisingly low levels of plaque buildup in their arteries compared to men. This finding underscores the need for a more nuanced understanding of heart health risk factors specific to women and could lead to earlier, more targeted interventions.
The study, which analyzed data from nearly 4,300 individuals experiencing chest pain, challenges conventional wisdom about the relationship between plaque accumulation and heart attack risk. Researchers found that although women generally had less plaque than men, their risk of adverse cardiovascular events increased significantly at lower levels of plaque burden – the amount of plaque relative to the size of the blood vessel. This suggests that traditional methods of assessing heart disease risk, often focused on the quantity of plaque, may underestimate the danger for women.
Plaque Burden and Risk: A Sex-Specific Difference
The research team discovered a key threshold: in women, the risk of major adverse cardiovascular events began to rise noticeably when plaque burden reached 20%, whereas in men, this increase wasn’t observed until plaque burden hit 28%. This steeper risk curve in women highlights the importance of considering sex-specific interpretations of plaque measurements for timely intervention. “This is an significant finding,” says Kevin Shah, M.D., cardiologist and program director of heart failure outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in Long Beach, CA. “These studies inform us that men and women are different in terms of plaque.”
The exact reasons behind this disparity remain unclear. While the study didn’t directly explore the underlying mechanisms, experts suggest several possibilities. Dr. Shah notes that differences in body size and heart size between men and women could play a role, although the plaque volume metric attempts to account for vessel size. However, Navjot Sobti, M.D., interventional cardiologist and women’s heart health specialist at Northwell’s Northern Westchester Hospital and Katz Institute for Women’s Health, points to the historical underrepresentation of women in cardiovascular research. “Many risk thresholds and imaging cutoffs were developed using male populations,” Dr. Sobti explains, “and focus on finding large artery blockages – what’s known as ‘obstructive disease.’ But women are more likely to have non-obstructive disease and types of heart attacks that don’t show large blockages on heart imaging.”
Beyond Blockages: Unique Heart Disease Presentations in Women
Women often experience heart attacks stemming from issues beyond simple arterial blockages, such as coronary artery spasm, spontaneous coronary artery tear or dissection (SCAD), or problems in the minor blood vessels of the heart. These conditions can be difficult to detect with traditional diagnostic tools and are often overlooked by standard risk models. As Dr. Sobti emphasizes, “women can have serious heart events at lower levels of visible plaque, highlighting the limitations of a one-size-fits-all approach and the need for sex-specific risk assessment and prevention strategies.”
Protecting Your Heart: What You Can Do
Regardless of gender, adopting a heart-healthy lifestyle is paramount. Both Dr. Shah and Dr. Sobti recommend following the American Heart Association’s Life’s Essential Eight – a set of cardiovascular health guidelines encompassing diet, exercise, weight management, sleep, smoking cessation and control of cholesterol, blood sugar, and blood pressure. However, Dr. Shah stresses that women should place even greater emphasis on these factors if any plaque volume is detected. Dr. Sobti adds that proactive screening, such as coronary calcium scoring, may be particularly beneficial for women, alongside earlier and more aggressive prevention methods like statins and blood pressure control.
Here are the Life’s Essential Eight, according to the American Heart Association:
- Eat better
- Be more active
- Quit tobacco
- Manage weight
- Get healthy sleep
- Control cholesterol
- Manage blood sugar
- Manage blood pressure
The findings from this study are prompting cardiologists to re-evaluate how they assess and manage heart disease risk in women. More sophisticated imaging techniques and a greater awareness of the unique ways heart disease can present in women are crucial for improving outcomes.
As research continues to unravel the complexities of cardiovascular health, a personalized approach – one that considers sex-specific factors – will be essential in preventing heart disease and saving lives.
Disclaimer: This information is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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