Overview
- In 4,267 stable outpatients without prior coronary disease, major adverse cardiovascular event risk began near 20–22% plaque burden in women versus 28% in men, with a steeper increase in women.
- Women had less plaque overall (55% with any plaque; median 78 mm3) than men (75%; 156 mm3) yet showed similar two‑year rates of death, nonfatal heart attack, or hospitalization for unstable angina.
- After multivariable adjustment, higher burdens of total, calcified, noncalcified, and low‑attenuation plaque were linked to events in women, whereas only low‑attenuation plaque was significant in men.
- Smaller coronary arteries make a given plaque volume a greater relative burden for women, indicating that uniform thresholds may underestimate women’s risk.
- The observational Circulation study analyzed quantitative CCTA over a median 26 months from the PROMISE trial subset, and investigators call for external validation before guideline changes.