Sex Differences in Coronary Plaque Burden and Event Risk (PROMISE Subset)

In a PROMISE trial subset, investigators reported that women undergoing coronary CT angiography had less overall coronary plaque than men, yet their subsequent clinical event rates over the reported follow-up window were not proportionally lower. The write-up framed this as a sex difference in how anatomic plaque burden relates to near-term outcomes, rather than a simple “less plaque equals less risk” pattern. It also noted that the plaque burden–risk relationship appeared to shift at different burden levels for women and men, with risk rising at lower thresholds in women.

The report described an analysis of PROMISE participants randomized to diagnostic evaluation with coronary CT angiography, focusing on 4,267 adults (average age 60; 51% women) followed for about two years. In the summary, detectable coronary plaque was reported less often in women than in men (55% vs 75%), and median total plaque volume was lower in women than men (78 mm3 vs 156 mm3). The composite outcome was described as death from any cause, nonfatal myocardial infarction, or hospitalization for chest pain, and was reported as broadly similar in women and men (2.3% vs 3.4%). The source presented these findings as lower plaque burden alongside broadly similar near-term event rates.

Beyond prevalence and volume, the authors described a sex-differential pattern for when risk increased as total plaque burden rose. In the summary, women’s risk was reported to begin rising at a lower burden threshold than men (20% vs 28%), and the increase in risk with higher burden was described as sharper in women. The interpretive explanation was attributed to the study authors, who noted that because women have smaller coronary arteries, a small amount of plaque can have a bigger impact. Overall, the emphasis remained on a reported difference in the burden–risk relationship by sex.