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Published on: July 3, 2018

Gender-related risk of myocardial infarction and subclinical coronary atherosclerosis: a Danish population cohort

Andreas Fuchs Larsen1,2, Jørgen Tobias Kühl1, Per Ejlstrup Sigvardsen1

  • 1Department of Cardiology, the Heart Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.

European Heart Journal
|August 12, 2026
PubMed

Insights

Subclinical coronary atherosclerosis is less common in women than men. However, for individuals with obstructive disease, both sexes face increased risks of myocardial infarction, with men showing a higher risk.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Epidemiology

Background:

  • Subclinical coronary atherosclerosis is a precursor to myocardial infarction.
  • Assessing its prevalence and impact in asymptomatic populations is crucial for preventive strategies.

Purpose of the Study:

  • To evaluate the prevalence of subclinical coronary atherosclerosis in asymptomatic Danish adults.
  • To determine the association between subclinical coronary atherosclerosis and major adverse cardiovascular events (MACE) including myocardial infarction, death, and coronary revascularization, stratified by sex.

Main Methods:

  • A cohort of 5710 women and 4293 men over 40 years old without symptoms underwent coronary computed tomography angiography.
  • Follow-up for a median of 6.0 years assessed the incidence of myocardial infarction, death or myocardial infarction, and clinically driven coronary revascularization.

Main Results:

  • Women exhibited less subclinical coronary atherosclerosis than men across all age groups and cardiovascular risk factor statuses (P < .0001).
  • Obstructive subclinical coronary atherosclerosis was associated with a 4.1-fold increased risk of myocardial infarction in women and a 12-fold increased risk in men.
  • The risk for death or myocardial infarction combined and clinically driven coronary revascularization was also elevated in individuals with obstructive disease, with similar trends observed across sexes.

Conclusions:

  • While women have less subclinical coronary atherosclerosis, the presence of obstructive disease significantly elevates myocardial infarction risk in both sexes.
  • The findings suggest that for equivalent degrees of atherosclerosis, women might have a comparatively lower risk of myocardial infarction than men.
Abstract

Keywords:
Coronary computed tomography angiographyGenderMyocardial infarctionPrimary preventionSexSubclinical coronary atherosclerosis

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