Atherosclerosis involves the growth of fatty plaques in blood vessel walls that weaken and obstruct those blood vessels. It is a universal condition; all older individuals exhibit some degree of plaque formation. A heart attack or stroke occurs when an unstable, fatty atherosclerotic plaque ruptures and the debris blocks a vessel somewhere downstream. Interestingly, atherosclerosis is quite different in character between the sexes. Until menopause, atherosclerosis proceeds more slowly in women, and as noted here women tend to exhibit lesser degrees of plaque in later life. That does not, unfortunately, translate into a lesser degree of risk of plaque rupture.
This study evaluated health data for more than 4,200 adults (more than half of whom were women) to compare how quantity of plaque influenced the risk of major heart conditions. The study included people with stable chest pain and no prior history of coronary artery disease. Participants were randomized to undergo diagnostic evaluation via coronary computed tomography angiography (X-ray images of the heart and blood vessels) and followed for about two years.
Fewer women had plaque in their coronary arteries than men (55% of women vs. 75% of men). Women also had a lower volume of artery plaque than men (a median of 78 mm^3 among women vs. 156 mm^3 in men). Despite less plaque, women were just as likely as men to die from any cause, have a non-fatal heart attack or be hospitalized for chest pain (2.3% of women vs. 3.4% of men). In addition, women faced increased heart risk at lower levels of plaque compared to men. For total plaque burden, women's risk began to rise at 20% plaque burden, while men's risk started at 28%. With increasing plaque levels, risk rose more sharply for women than for men.
"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."
Link: https://newsroom.heart.org/news/women-may-face-heart-attack-risk-with-a-lower-plaque-level-than-men
View the full article at FightAging
