Women show similar heart event risk at lower coronary plaque burden than men, PROMISE analysis finds
Feb 24th 2026
Analysis of nearly 4,300 outpatients from the PROMISE trial using cardiac CT found women had smaller plaque volumes but similar major adverse cardiovascular event rates to men, with risk appearing at a lower vessel-size adjusted plaque burden in women.
- Study used CCTA data from about 4,300 stable outpatients with chest pain and no prior coronary artery disease and followed them for a median 26 months.
- Women had lower median total plaque volume but a similar vessel-size adjusted total plaque burden compared with men.
- Rates of major adverse cardiovascular events were similar in women and men over follow-up.
- Risk of events emerged at a lower total plaque burden in women, roughly 20 percent versus roughly 28 percent in men.
- Women showed a steeper increase in event risk at lower plaque burden while men required larger plaque amounts for rising risk, and these sex differences persisted after adjusting for traditional risk factors and plaque features.
- Implication is that applying uniform plaque thresholds across sexes may underestimate cardiovascular risk in women and supports sex specific interpretation of plaque metrics.