Men and women have different risk profiles when it comes to coronary artery disease, with women often developing symptoms later than men. They are more likely to have high blood pressure and dyslipidemia, a condition characterized by abnormal levels of lipids, or fats, in the bloodstream.
Women are also more likely to be diagnosed with non-obstructive coronary artery disease, a condition that leads to a higher number of adverse events than obstructive disease.
Coronary Artery Disease in Women
Women tend to have less arterial plaque. That may sound like a good thing, but unfortunately, a recent study shows that it is not. Even with less plaque, a woman’s risk of a heart attack or other cardiovascular event due to plaque deposits is higher than that of a man, an international team led by researchers at Harvard University and Massachusetts General Hospital found.
Women have smaller coronary arteries, so a smaller amount of plaque can have a bigger effect on cardiac risk.
Study Findings
Researchers measured the plaque in the arteries of more than 4,200 men and women who had an average age of 60 years old and had enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE). The team used a procedure that significantly improves risk prediction for coronary events — coronary computed tomography angiography, an X-ray of the heart and blood vessels that measures total plaque volume relative to total blood vessel volume.
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The researchers found that fewer women had arterial plaque: 55 percent of women had plaque compared to 75 percent of men. They also had roughly half the volume of plaque compared to men.
Women’s heart attack risk rose more sharply than men’s as plaque levels increased, particularly after they went through menopause.
Risk Assessment
Despite having less plaque, however, women were just as likely as men to be hospitalized for chest pain, have a non-fatal heart attack or die from any cause because their risk of heart attack started at lower levels of plaque than men.
Women’s serious heart risk began to increase at a plaque burden of 20 percent; men’s risk began to increase at 28 percent.
Borek Foldyna, senior author on the study and an assistant professor of radiology at Harvard Medical School, said in a statement that women are not protected from coronary events despite having lower plaque volumes.
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According to the report, standard definitions of high cardiac risk, based as they have been on men, are therefore likely to underestimate the risk in women.
Researchers were surprised at how subtle these differences were. The study findings showed that the relationship between plaque and cardiovascular risk may differ in degree rather than in kind, Jan Brendel, first author on the study and a postdoctoral fellow at Harvard Medical School and Massachusetts General Hospital, said.
The study and a related editorial are published in Circulation: Cardiovascular Imaging.
Going forward, the researchers are interested in looking at age-specific and gender-specific plaque burden in relation to coronary risk.
Ultimately, the goal is to move toward more individualized cardiovascular risk assessment, where imaging tests are interpreted in context, not uniformly across populations, said Brendel.
