{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:15:05Z","timestamp":1790946905740,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Quantitative coronary plaque measures differ in prognostic value between women and men. It remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes. We aimed to compare cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We analyzed data from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary computed tomography angiography arm, quantifying total coronary plaque volume and burden (plaque burden [PB]; % vessel volume), including calcified, noncalcified, and low-attenuation components. Associations with major adverse cardiovascular events (death, myocardial infarction, or unstable angina hospitalization) were assessed using sex-stratified spline Cox models over a median 26 months (interquartile range, 18\u201334).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 4267 patients (mean age, 60.4\u00b18.2; 2199 women), plaque was less frequent in women (55% versus 75%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), with lower total plaque volume but similar total PB and incident major adverse cardiovascular events (2.3% versus 3.4%). Major adverse cardiovascular event risk became elevated at lower PB in women than in men: for total PB, hazard ratio crossed 1.0 at 20% in women versus 28% in men, reaching hazard ratio 1.5 at 32% in women versus 42% in men, respectively. Noncalcified PB showed a similar pattern, crossing hazard ratio 1.0 at 7% in women versus 9% in men; hazard ratio 1.5 at 13% in women versus 20% in men. Findings were similar after adjustment for atherosclerotic cardiovascular disease risk score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In women, major adverse cardiovascular events appeared to emerge at a lower PB, and to rise more sharply. Findings support sex-specific interpretation of coronary computed tomography angiography-derived plaque metrics for timely intervention in women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT01174550.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.019011","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:00:12Z","timestamp":1771840812000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Risk in Women Emerges at Lower Coronary Plaque Burden Than in Men: PROMISE Trial"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"nct01174550","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-610X","authenticated-orcid":true,"given":"Jan M.","family":"Brendel","sequence":"first","affiliation":[{"name":"Department of Radiology, Cardiovascular Imaging Research Center (CIRC) (J.M.B., J.K., N.M.K., I.L.L., M.J., M.C.L., M.T.L., B.F.), Massachusetts General Hospital, Harvard Medical School, Boston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mayrhofer","sequence":"additional","affiliation":[{"name":"Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Germany (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-6260","authenticated-orcid":true,"given":"J\u00falia","family":"Kar\u00e1dy","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cardiovascular Imaging Research Center (CIRC) (J.M.B., J.K., N.M.K., I.L.L., M.J., M.C.L., M.T.L., B.F.), Massachusetts General Hospital, Harvard Medical School, Boston."},{"name":"Department of Medicine, Boston Children\u2019s Hospital, MA (J.K.)."},{"name":"Heart and Vascular Center, Semmelweis University, Budapest, Hungary (J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-991X","authenticated-orcid":true,"given":"M\u00e1rton","family":"Kolossv\u00e1ry","sequence":"additional","affiliation":[{"name":"Metabolism Unit (M.K.), Massachusetts General Hospital, Harvard Medical School, Boston."},{"name":"Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.)."},{"name":"Physiological Controls Research Center, University Research and Innovation Center, \u00d3buda University, Budapest, Hungary (M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra M.","family":"Kerkovits","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cardiovascular Imaging Research Center (CIRC) (J.M.B., J.K., N.M.K., I.L.L., M.J., M.C.L., M.T.L., B.F.), Massachusetts General Hospital, Harvard Medical School, Boston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel L.","family":"Langenbach","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cardiovascular Imaging Research Center (CIRC) (J.M.B., J.K., N.M.K., I.L.L., M.J., M.C.L., M.T.L., B.F.), Massachusetts General Hospital, Harvard Medical School, Boston."},{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Germany (I.L.L., 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