Less plaque, higher risk? Females show greater vulnerability to cardiac events

• A new study shows that, despite having less plaque overall, females experience cardiovascular events at a similar rate to males, suggesting that they face a risk at lower levels of plaque buildup.
• In females, cardiovascular risk increased earlier and more steeply at lower plaque levels, suggesting that uniform plaque thresholds may underestimate risk in females.
• As such, the study’s findings indicate that sex-specific interpretation could improve risk assessment.

Cardiovascular diseases are the leading cause of death globally, with heart disease representing the leading cause of death in the United States. Coronary artery disease (CAD) is the most common type of heart disease, with roughly 1 in 20 adults ages 20 and older having CAD.

Previous research has highlighted sex-specific differences for CAD, with females having a significantly greater risk of experiencing complications. Notably, plaque characteristics differ between males and females.

Females often have a smaller coronary artery diameter, meaning they can present with a higher total plaque burden. This describes the total amount of fatty deposits within an artery, typically expressed as the percentage of the vessel area occupied by plaque.

Now, a study published in Circulation: Cardiovascular Imaging suggests that females may face a heightened risk of major cardiac events at lower levels of coronary plaque compared with males.

These findings indicate that using the same plaque thresholds for both sexes could underestimate cardiovascular risk in females.