A GROUNDBREAKING study has highlighted key differences in how coronary artery disease (CAD) affects men and women, revealing that women face a higher relative risk of major cardiovascular events despite typically having less plaque burden. The findings, published from the global CONFIRM2 registry, suggest the need for more tailored prevention and treatment strategies.
The study analysed 3,551 symptomatic patients with suspected CAD using artificial intelligence-based quantitative coronary computed tomography (AI-QCT). Researchers assessed 16 CAD-related features to determine their predictive value for major adverse cardiovascular events (MACE), including death, heart attack, stroke, unstable angina, and heart failure.
Over an average follow-up period of 4.8 years, MACE occurred in 3.2% of women and 6.1% of men. While men had significantly higher total plaque volume (TPV), non-calcified plaque (NCP), calcified plaque (CP), and percentage atheroma volume (PAV), women experienced a greater relative risk increase for MACE with rising plaque burden. For every 50mm³ increase in TPV, women’s relative risk rose by 17.7%, compared to 5.3% in men. Similar trends were observed for NCP (27.1% vs. 11.6%) and CP (22.9% vs. 5.4%).
“These results suggest that while men exhibit higher overall plaque burden, women experience a more pronounced increase in risk for cardiovascular events per unit increase in plaque,” said the study’s lead author. “This underscores the importance of sex-specific risk assessment in coronary artery disease.”
A particularly notable finding was the prevalence of high-risk plaque (HRP), a marker of vulnerability to cardiovascular events. HRP was significantly more common in men (9.2% vs. 2.5%), yet women’s MACE risk was disproportionately elevated for equivalent plaque volumes.
These findings suggest a potential need for more aggressive preventive strategies in women with CAD, even if their absolute plaque burden appears lower than in men. The study’s authors advocate for refined treatment guidelines that account for these sex-based differences to improve cardiovascular outcomes.
As AI-powered imaging advances, such research continues to illuminate the nuanced ways CAD affects men and women differently, paving the way for more personalised and effective treatments.
Reference
Feuchtner GM et al. AI-Quantitative CT Coronary Plaque Features Associate with a Higher Relative Risk in Women: CONFIRM2-Registry. Circ Cardiovasc Imaging. 2025;DOI:10.1161/CIRCIMAGING.125.018235.
