Women face a higher risk of major coronary events, including heart attacks, at lower levels of arterial fatty deposits than men, researchers said on Monday, urging that gender differences be included in cardiovascular risk assessment and treatment.
They have found that the risk of major adverse cardiovascular events — defined as hospitalisation for chest pain, heart attacks, or death — emerges at a total plaque burden of 20 per cent in women versus about 28 per cent in men.
The total plaque burden is the overall volume of fatty deposits relative to the size of blood vessels.
“Our findings underscore that women are not protected from coronary events even with lower plaque volumes,” said Borek Foldyna, a cardiovascular radiologist and faculty member at Harvard Medical School who led the study.
“Because women have smaller coronary arteries, even a small amount of plaque can have a bigger impact,” Foldyna said in a media release accompanying the study published in the journal Circulation from the American Heart Association.
The researchers studied 4,267 patients from 193 sites across the US and Canada, with an average age of 60, slightly more than half of whom were women. Women had fewer plaques than men (55 per cent versus 75 per cent) and smaller plaque volumes, but their hearts appeared more sensitive to plaque.
For women, the risk of major cardiovascular events began to rise at 20 per cent total plaque burden, compared with 28 per cent in men. A similar pattern was observed for softer, non-calcified plaque: the risk emerged at 7 per cent in women versus 9 per cent in men, and women’s risk rose to 1.5 times higher at 13 per cent compared with 20 per cent for men.
Cardiologists in India say these findings carry particular urgency locally, with data suggesting Indian women face earlier-onset heart disease and higher prevalence of other risk factors, underscoring the need for gender-specific assessment and care.
“The key message is simple but powerful — women’s hearts deserve tailored science,” Roopali Khanna, a cardiologist at the Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow who was not associated with the study, told The Telegraph.
“Heart disease in women needs to be recognised early, understood better and treated with approaches designed specifically for women. By raising awareness, encouraging timely checkups and supporting women-focused research, we can save countless lives,” she said.
Cardiologists have long known that measures of plaque buildup can help predict heart problems, and have suspected that these measures may work differently in women and men. Until this study, it was unclear whether cardiovascular risk rises proportionally across sexes.
Khanna added that multiple factors complicate the challenge in India.
“Women tend to develop heart disease at a younger age than their western counterparts. Rising rates of diabetes, high blood pressure and abdominal obesity, combined with social or cultural factors — such as prioritising family over personal health and limited access to regular check-ups — often lead to late detection, when the disease is already advanced,” she said.
Ambuj Roy, a cardiologist at the All India Institute of Medical Sciences in New Delhi, said: “Women have been much neglected in vascular disease because of lower representation in clinical studies. Their risk pattern, presentation and outcomes are quite different — we need to heed this.”
An independent 2024 study of 31,000 people aged 60 or older in India found that women were more likely than men to have cardiovascular disease — about 38 per cent of women versus 31 per cent of men — representing a 33 per cent higher overall risk.
“The greater effect of plaque on women could be one possible explanation, alongside other factors such as abdominal obesity,” said Abhay Gaidhane, director of the School of Public Health and Epidemiology at Datta Meghe Institute of Higher Education and Research in Wardha, Maharashtra.