25 February 2026 (Navroze Bureau) : New research is challenging long-held assumptions about heart disease, suggesting that women may face an increased risk of heart attacks even with lower levels of artery-clogging plaque compared to men. The findings highlight important biological differences in how heart disease develops and progresses in women, underscoring the need for more tailored approaches to diagnosis and prevention.
Traditionally, doctors have assessed heart attack risk based on the amount of plaque buildup in the coronary arteries. Plaque, made up of cholesterol, fat, calcium, and other substances, narrows blood vessels and restricts blood flow to the heart. Higher plaque burden has long been associated with greater risk. However, the latest evidence suggests that in women, even modest plaque accumulation can be dangerous.
fwResearchers found that women often experience heart attacks despite having less visible blockage in their arteries. This contrasts with men, who typically develop larger, more obstructive plaques before suffering major cardiac events. In women, smaller plaques are more likely to rupture, triggering blood clots that can suddenly block blood flow and cause a heart attack.
Experts say this difference may be linked to variations in plaque composition and blood vessel biology. Women are more likely to have plaques that are softer and more prone to rupture, while men tend to develop harder, calcified plaques that gradually narrow arteries. Hormonal factors, inflammation, and differences in blood vessel size and function may also play a role.
The findings help explain why heart disease in women is often underdiagnosed or diagnosed later than in men. Many women with chest discomfort or other symptoms are told their arteries are “not blocked enough” to cause concern, leading to delays in treatment. In reality, these women may still be at significant risk.
Another challenge is that women frequently experience different heart attack symptoms than men. Instead of classic chest pain, they may have shortness of breath, nausea, fatigue, jaw pain, or back pain. When combined with less obvious artery blockage on scans, these atypical symptoms can make diagnosis more difficult.
Cardiologists stress that the research reinforces the need for gender-specific risk assessment. Relying solely on the degree of artery narrowing may miss high-risk women. Instead, doctors may need to focus more on plaque characteristics, inflammation markers, and overall cardiovascular risk profiles.
The findings also have implications for prevention. Women with risk factors such as high blood pressure, diabetes, smoking, obesity, stress, or a family history of heart disease should take symptoms seriously, even if imaging tests show only mild plaque buildup. Lifestyle changes, cholesterol management, and preventive medications may be beneficial earlier than previously thought.
Public health experts note that heart disease remains the leading cause of death among women worldwide, yet awareness remains low. Many women still believe cancer is their biggest health threat, underestimating cardiovascular risks. Studies like this highlight why early screening and education are critical.
Doctors are now calling for updated clinical guidelines that better reflect how heart disease affects women. This includes improved imaging techniques, greater use of preventive therapies, and more research focused specifically on female heart health rather than applying findings largely based on male patients.
The takeaway is clear: for women, “less plaque” does not always mean “low risk.” Recognising these differences could help save lives by ensuring earlier diagnosis, more aggressive prevention, and more personalised heart care for women.
Summary
New research shows women may face higher heart attack risk even with lower artery plaque levels, highlighting gender differences in heart disease and the need for improved, women-focused diagnosis and prevention.