Medical News Today (MNT)Less Plaque, Higher Risk? Females Show Greater Vulnerability to Cardiac Events

Females experience comparable MACE rates to males despite lower absolute plaque volumes, according to a PROMISE trial analysis of nearly 4,300 stable chest pain patients published in Circulation: Cardiovascular Imaging. Cardiovascular risk in females accelerated at a total plaque burden of ~20%, versus ~28% in males, suggesting uniform plaque thresholds systematically underestimate risk in women.

🔬 Clinical Considerations

• Smaller coronary artery diameter in females means lower absolute plaque volume can reflect equivalent relative disease burden, explaining similar MACE rates across sexes
• Risk rose more steeply at lower plaque levels in females vs a gradual increase in males, a pattern that persisted after adjusting for traditional risk factors and high-risk plaque findings
• No sex-specific plaque burden thresholds currently exist in routine practice; researchers caution against implementing cutoffs before further validation
• Females have been historically undertreated in cardiovascular care, making this a high-stakes gap in current risk stratification tools

⚡ Practice Applications

• Avoid interpreting low absolute plaque volume as low risk in female patients
• Prioritize plaque burden (vessel size-adjusted) over total plaque volume when assessing female cardiovascular risk
• Integrate imaging findings with full clinical risk factor profiles before classifying female patients as low risk
• Follow developing literature on sex-specific and age-specific plaque burden thresholds for future guideline updates

More on Coronary Artery Disease (CAD)