Heart disease remains the leading cause of death for both men and women. However, new research highlighted by the American Heart Association reveals an important difference: women may develop heart attack risk at lower levels of coronary plaque compared to men.
This finding is changing how cardiologists think about prevention and why advanced imaging such as Coronary CT Angiography (CCTA) is becoming an essential tool in modern cardiovascular care.
What the New Research Shows About Women and Heart Disease
In a new study published in the New England Journal of Medicine, researchers found:
- Women may experience symptoms and/or heart attacks with less overall plaque burden
- Smaller amounts of vulnerable plaque can still carry significant risk
- Traditional testing may underestimate cardiovascular risk in women
This helps explain why many women with chest discomfort are told their tests look “normal,” yet remain at risk for future cardiac events. Heart disease does not always present the same way in women as it does in men.
Understanding Coronary Plaque
Coronary artery disease develops when fatty deposits, called plaque, build up inside the heart’s arteries. Traditionally, risk was judged by how much plaque narrowed an artery.
For decades, cardiovascular risk assessment has focused largely on how much blockage exists in the arteries. But emerging research suggests the story is more nuanced, especially for women. Patients were reassured if blockages were considered “mild” or non-obstructive.
Something critical to know is that heart attacks often occur before arteries become severely blocked. Plaque morphology and plaque stability, not just plaque size plays a major role in who develops heart attack.
Why Traditional Heart Tests May Miss Early Disease
Common cardiac evaluations such as stress tests primarily detect:
- Reduced blood flow
- Advanced artery narrowing
- Exercise-induced ischemia
However, moderate plaque burden may not limit blood flow enough to appear abnormal on these tests. This is especially important for women, who more commonly have smaller sized arteries. As a result, less amount of plaque may have significant impact in women.
A New Era in Cardiac Imaging
Holy Name is one of the few hospitals worldwide utilizing photon-counting CT (PCCT) for cardiac imaging. This new technology provides enhanced image resolution, tissue differentiation, and diagnostic accuracy to produce clearer pictures of the heart. Holy Name is leveraging this new technology for a cardiac clinical trial called TRANSFORM. This groundbreaking study explores whether coronary computed tomography angiography (CCTA) scans, coupled with AI, can help prevent heart attacks in individuals without known heart disease and detect other cardiac conditions earlier in individuals without known heart disease. Participants in the study will receive additional heart scans in 2-5 years, to check the status of plaque build-up in their arteries over time. The findings may help revolutionize future cardiac care.
The Role of CCTA: Seeing Plaque Directly
CCTA represents a major advancement because it allows physicians to visualize plaque. CCTA provides:
- Detailed 3D images of coronary arteries
- Detection of early and non-obstructive plaque
- Identification of high-risk plaque characteristics
- Measurement of total plaque burden
- Better individualized risk assessment
Instead of asking “Is there a blockage?” CCTA helps answer: “How much disease is present, and how dangerous is it?”
Why This Matters for Prevention:
Early plaque detection allows physicians to intervene sooner by enabling personalized cholesterol management and lifestyle optimization, prescribing preventive medications when appropriate, and establishing long-term monitoring of plaque progression. For many patients, particularly women, this approach shifts care from reactionary to prevention.
Modern cardiology is moving beyond a one-size-fits-all model and testing. Each patient’s risk depends on plaque biology, inflammation, genetics, and lifestyle factors. Advanced imaging like CCTA supports a more precise strategy.
When Should You Consider CCTA?
You may benefit from evaluation if you have:
- Chest discomfort or unexplained shortness of breath
- Family history of heart disease
- Elevated cholesterol or diabetes
- Intermediate cardiovascular risk
- Persistent symptoms despite normal stress testing
Your Heart Deserves Early Insight:
Heart disease often develops silently. New research reminds us that risk, especially in women, may appear earlier than previously recognized.
Seeing plaque early allows us to change the future of heart health.
For more information or a consultation, contact Dr. Jaffar Raza, interventional cardiologist at Holy Name at (551) 242-2555.
