PROMISE: Women face higher heart disease risk at lower plaque burdens

Women are at higher risk of adverse cardiovascular events even when they have lower levels of plaque burden, according to a study published February 23 in Circulation: Cardiovascular Imaging.

The study findings add to existing research that seeks to address “whether cardiovascular risk increases proportionally with plaque extent in both sexes,” wrote a team led by Jan Brendel, MD, of Massachusetts General Hospital and Harvard Medical School in Boston.

Quantitative coronary plaque measures differ in prognostic value between women and men, the authors noted, but it remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes. To investigate, the team conducted a study that included data from 4,267 patients who participated in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary CT angiography (CTA) arm. It quantified total coronary plaque volume and burden — including calcified, noncalcified, and low-attenuation components — and assessed any associations with major adverse cardiovascular events such as death, myocardial infarction, or unstable angina hospitalization.

The group reported the following:

• Plaque was less frequent in women (55% vs. 75% in men; p < 0.001), with lower total plaque volume but similar total plaque volume and incident major adverse cardiovascular events (2.3% in women, 3.4% in men).
   
• Major adverse cardiovascular event risk increased at lower plaque burden in women than in men: For total plaque burden, hazard ratio surpassed 1 at 20% in women compared with 28% in men (hazard ratio of 1.5 in 32% in women vs. 42% in men).
   
• Noncalcified plaque burden showed a similar pattern, surpassing a hazard ratio of 1 at 7% in women compared with 9% in men (with a hazard ratio of 1.5 in 13% of women vs. 20% of men).

The team also found that these findings were similar after adjustment for atherosclerotic cardiovascular disease risk score.

The study results underscore the importance of “sex-specific interpretation of coronary CT angiography-derived plaque metrics for timely intervention in women,” the authors concluded.

Access the full study here.