February 25, 2026
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Even though women usually have less artery-clogging plaque than men, a study of nearly 4,200 adults found that women don't need as much buildup to be at risk of a heart attack and chest pain.
Women have lower amounts of harmful plaque in their arteries compared with men, but the discrepancy doesn't diminish a woman's risk of having a heart attack, new research shows. In fact, women with plaque in their arteries may face similar or greater risks.
A study out of Mass General Brigham, a teaching affiliate of Harvard Medical School, reviewed scans of coronary arteries from nearly 4,300 men and women whose images were part of a larger investigation of patients with chest pain.
The analysis found only 55% of the women, all over 50 years old, had a buildup of plaque linked to cardiovascular disease. Scans from the men — all 45 and older — showed 75% had coronary plaque.
The buildup of plaque is a combination of cholesterol, fat, calcium and other substances that inhibit blood flow to the heart. It can be detected using coronary CT angiograms, which are used to assess people with chest symptoms and other known risk factors.
Despite the differences in the scans of women and men, researchers found women had a comparatively higher risk of plaque leading to heart problems. This is partly explained by women having smaller coronary arteries than men, which lowers the risk threshold for women even when their total plaque levels are below those seen in men.
Women needed a 20% plaque buildup in their arteries to be at risk of having a heart attack or developing chest pain that would require a hospital visit. Among men, that risk only appeared in those who reached a 28% plaque buildup in their coronary arteries. The study also found that as plaque levels increased, the heart risks for women rose more steeply than for men.
"Risk of adverse outcomes appeared to emerge at lower plaque burden in women than in men, so perhaps our threshold for initiating various medical treatments should be adjusted accordingly," Julie Marcus, a cardiologist who was not involved in the study, told Stat News. "The goal would be to help identify women at risk of coronary artery disease and future events earlier, so we can improve the prompt initiation of preventative medications and strategies."
The research, published Monday in the journal "Circulation: Cardiovascular Imaging," sheds new light on how women's heart health risks may be underestimated. None of the men and women in the study had prior coronary artery disease before their scans were taken for chest pain.
The women in the study showed fewer kinds of plaques with high-risk characteristics, but they were just as likely to have major heart problems over time as the men. Even though heart disease and clogged arteries are more commonly linked to men, women account for about 47% of U.S. deaths from heart disease.
The study suggests physicians and their patients need improved guidelines to account for the biological differences between men and women.
"Our findings underscore that women are not 'protected' from coronary events despite having lower plaque volumes," senior author Borek Foldyna, an assistant professor in radiology at Harvard Medical School, said in a news release from the American Heart Association. "Because women have smaller coronary arteries, a small amount of plaque can have a bigger impact. Moderate increases in plaque burden appear to have disproportionate risk in women, suggesting that standard definitions of high risk may underestimate risk in women."
Jan Brendel, the study's lead author, said the next step will be changing the way plaque is evaluated in patients.
"Based on the apparent differences in risk trajectories between men and women, incorporating sex, and even age, into the interpretation of plaque metrics is an important next step toward more individualized risk assessment," Brendel said.
