Why low plaque doesn’t mean low heart disease risk for women

The American Heart Association estimates that 18 million Americans have heart disease, approximately 6 million of which are women. Although fewer women get diagnosed with heart disease compared to men, it remains the leading cause of death for women in the U.S., highlighting a critical need for further research into sex-specific risk factors, diagnostic tools and patterns of disease development.

How is heart disease typically assessed?

Heart disease risk is often assessed by measuring the amount of plaque buildup in your arteries. Health care providers commonly use CT calcium scoring, lab work and other diagnostic tests to evaluate cardiovascular health. While these tests play a critical role in diagnosing coronary artery disease (CAD) and identifying your risk, they don’t always capture the full picture of your health, particularly for women.

Even with low calcium scores, many women still experience cardiac events, suggesting that traditional markers of plaque buildup may underestimate the true risk they face.

Why is the assessment ineffective for women?

“There are unique, women-specific risk factors that contribute to higher cardiovascular risk,” says Dr. Namra Butt, a cardiologist and lipid specialist at Advocate Health Care. “These include adverse pregnancy outcomes and complications, such as preeclampsia and gestational diabetes, as well as premature menopause, which increases a woman’s lifetime risk of coronary artery disease by 40%.”

She says risk also further accelerates after menopause, as the loss of estrogen negatively impacts lipid levels, vascular function and inflammation.

“Many of the factors driving women’s risk for heart disease are not captured by traditional assessments or standard risk calculators, emphasizing the need to reevaluate current approaches to diagnosis, improve awareness and ensure women receive earlier, more personalized heart care,” Dr. Butt says.

How to learn about your risk

Regularly seeing your primary care provider is an important first step toward appropriate evaluation and referral. They’ll review your personal and family health history, lifestyle habits and symptoms to help guide your care.

Want to learn more about your risk for heart disease? Take a free online quiz.