NEW DELHI (24 February 2026) — A landmark study led by researchers at Harvard Medical School has revealed that women are at a significant risk of heart attacks even with relatively low levels of artery-clogging plaque. The findings, published this week in the journal Circulation: Cardiovascular Imaging, suggest that current medical standards for defining “high cardiovascular risk” may be underestimating the danger for women, who typically possess smaller coronary arteries.+1
Key Findings: The “Plaque Gap”
The study analysed health data from over 4,200 outpatients (including approximately 2,200 women) with stable chest pain and no prior history of heart disease. Researchers used advanced coronary CT angiography to measure total plaque volume and “plaque burden”—the proportion of plaque relative to the size of the blood vessel.+1
The data highlighted a distinct biological discrepancy between sexes:
- Lower Prevalence, Equal Risk: Only 55% of women had detectable plaque compared to 75% of men. Women also had roughly half the median plaque volume (78 mm³ vs 156 mm³). Despite this “cleaner” appearance, women experienced major heart events at nearly identical rates to men.+2
- Lower Threshold for Danger: Cardiovascular risk in women began to rise at a 20% plaque burden, whereas the risk for men did not emerge until it reached 28%.
- Sharper Risk Escalation: Once plaque began to accumulate, the risk of a heart attack or death rose much more steeply for women than for men, especially during the post-menopausal phase.
Why Smaller Arteries Matter
“Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes,” stated senior author Borek Foldyna, an assistant professor of radiology at Harvard Medical School.
The biological explanation lies in the physical dimensions of the heart. Because women generally have smaller coronary arteries, even a modest amount of plaque can create a disproportionately high obstruction. This suggests that a level of plaque considered “mild” or “moderate” in a male patient could be clinically dangerous for a female patient.+1
Moving Toward Sex-Specific Risk Assessment
The study’s authors and leading cardiologists are now calling for a shift in how cardiac imaging is interpreted. Current uniform thresholds often fail to account for these fundamental biological differences, potentially leading to missed opportunities for early intervention in women.
Stacey E. Rosen, volunteer president of the American Heart Association, noted that this research is an “overdue recognition” of how cardiovascular disease manifests differently across genders. The findings suggest that clinicians should consider lower, sex-adjusted thresholds for initiating preventative treatments like statins or blood pressure medication in female patients showing signs of arterial buildup.+1
Sources
- Circulation: Cardiovascular Imaging: “Risk in Women Emerges at Lower Coronary Plaque Burden Than in Men: PROMISE Trial” (23 February 2026)
- Press Trust of India (PTI): “Even lower levels of artery-clogging plaque may cause heart attack risk in women…” (24 February 2026)
- American Heart Association: News Release – “Women may face heart attack risk with a lower plaque level than men” (23 February 2026)
- Harvard Medical School / Mass General Brigham: Research Brief (24 February 2026)
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