❤️‍🩹 Less Plaque Doesn’t Mean a Safe Heart–Especially for Women

If there’s one issue that makes me completely mental it’s how poorly women have been studied and treated when it comes to cardiovascular disease. As I wrote in my blog three years ago:

I’ve been writing this same story for years: millions of women are dying unnecessarily from heart disease. We don’t receive the same preventative care. We don’t receive the same emergency care. We don’t always recognize our symptoms. Hell, just over half of us even realize that heart disease is our number one killer. And despite 20 years of the American Heart Association’s Go Red for Women Campaign designed to raise awareness of these issues, two recent studies show we are still faring far worse in cardiac care than men.

I’ve encouraged women to know their risks. A couple of years ago, I got a Cleerly-enabled coronary computed tomography angiography (CCTA), which uses AI-enabled software to help characterize coronary plaque composition and cardiovascular disease risk, and did a podcast about it here.

Well, today a study hit my desk that shows that even that might not be enough, because (and I shouldn’t be surprised, though somehow I was) when it comes to women: “less plaque” does not equal “less risk.”

Higher Risk At Lower Plaque Particularly Post Menopause

In the study published in Circulation: Cardiovascular Imaging, an American Heart Association journal, researchers looked at more than 4,200 adults with stable chest pain and no prior heart disease and measured how much plaque they had in their coronary arteries. The good news: fewer women had plaque in their coronary arteries than men (55% of women vs. 75% of men). Women also had, on average, less plaque volume than men—about half as much. Yet their rates of heart attack, chest‑pain hospitalization, and death over two years were about the same.

Worse, women’s risk started to rise at a lower plaque burden than men’s, and once it rose, it climbed faster. Because women’s coronary arteries tend to be smaller, a “moderate” amount of plaque can narrow things down more, so the same-looking scan can be a bigger problem in a woman than in a man. That means risk thresholds built on male data may underestimate women’s danger zone. Women also have more microvascular heart disease.

“Our findings underscore that women are not ‘protected’ from coronary events despite having lower plaque volumes,” said senior author Borek Foldyna, M.D., Ph.D., an assistant professor in radiology at Harvard Medical School in Boston in a press release. “Because women have smaller coronary arteries, a small amount of plaque can have a bigger impact. Moderate increases in plaque burden appear to have disproportionate risk in women, suggesting that standard definitions of high risk may underestimate risk in women.”

“There is an overdue recognition of fundamental, biological differences in the way health conditions manifest in women vs. men, and these differences can influence everything from risk factors to symptoms to treatment response,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, also in the release.

What does this all mean for us right now?

If imaging ever shows any plaque, don’t let anyone wave it off as “nothing to worry about” just because it’s not severe by traditional standards.

Ask direct questions: What’s my actual plaque burden? How does this level affect risk in women? What’s our plan—lifestyle, meds, follow‑up—to keep this from progressing?

Remember that being fit is protective but doesn’t make us invincible. If you’re unsatisfied with the answers and care you receive, don’t be shy about a second opinion. Your heart is worth it.

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👀 What Caught My Eye

A cool new mouse study suggests that fitness gains may start in the brain (which, when you stop to think about it, makes complete sense). In a study published in Neuron, scientists put mice on tiny treadmills and found that repeated workouts strengthened a cluster of “endurance neurons” in a brain area that helps manage metabolism and blood sugar. Over a few weeks, these neurons became more responsive and formed more connections with each other, as if the brain were keeping a memory of the training and using it to better handle future efforts.

When researchers used a light-based technique to temporarily switch these neurons off after runs, the mice stopped improving: they got tired faster and missed out on the usual fitness gains, even though their training stayed the same. On the flip side, when the researchers turned the neurons up, it helped the mice run farther and faster, suggesting that the brain is a key player in building endurance. The work needs to be replicated in humans, but it’s pretty fascinating stuff, and I think may be another way that exercise is good for your brain—it keeps it literally engaged.

🔥Badass Athlete of the Week Goes To…

Putting our hands together this week for American wheelchair curler Laura Dwyer, 48, who made her Paralympic debut at the Milano Cortina 2026 Winter Games, competing in the inaugural mixed doubles wheelchair curling event alongside partner Steve Emt. Dwyer and reached the semifinals before ultimately finishing in fourth place after a narrow 11-10 loss to Latvia in the bronze medal game.

Dwyer picked up wheelchair curling seven years after a life-altering accident in 2012 when she was working as a landscaper and a 1,000-pound tree branch fell on her from 40 feet up, leaving her paralyzed from the waist down. Before her Paralympic debut, she represented Team USA at the 2023, 2024, and 2025 world championships in the mixed team competition and is a 2025 wheelchair mixed doubles national champion. Her result in the 2026 Games marks Team USA’s best-ever Winter Paralympics finish in wheelchair curling.

Way to go, Laura!

👉Want a chance to be featured? Click here to share your badass story

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👩🏻‍💻 Hit Play Research Round Up

We spend a lot of time scouring the latest research for news you can use to stay strong and feisty forever. Here’s what’s making waves this week:

🏋️‍♀️ Lift weights for a younger brain. A new study using brain‑age “clocks” found that resistance training (moderate and heavy) slowed brain aging by about –1.4 to –2.3 years over two years in a one year trial. Heavy training also boosted connectivity in the prefrontal cortex, a key area for thinking and decision‑making. These effects showed up across the whole brain, not just in isolated networks, suggesting broad protection against brain aging. Bottom line: lifting really can be brain training.

🤾🏾‍♀️ The more intense and recreational your workouts, the lower your odds of feeling depressed. In a study of nearly 39,000 adults, higher‑intensity physical activity and more time spent in recreational exercise were most strongly linked with fewer depressive symptoms. Whether it’s lifting, running, racket sports, or circuit training, turning up the effort in activities you enjoy may help boost your mood.

🦴 Starting hormone therapy early in menopause lowers osteoporosis and fracture risk, according to new data from the 2026 AAOS Annual Meeting. Among 137,000+ postmenopausal women, those starting hormone therapy within 1 year of diagnosis had 18% lower osteoporosis risk and up to 13% reduced fracture risk at 5 years vs. non-users. Talk to your doctor about your own bone health plan.

What's On My Mind...

Power. I’ve been thinking a lot about how so many folks are so quick to pounce all over someone online for even just the smallest transgressions. I think it has a lot to do with power. There are big, often awful, things happening in our world that we can feel absolutely powerless to do anything about. We can feel powerless in our lives. Our phones give us some modicum of power to do something about something. I’m just unconvinced it’s making the world a better place.

Listen to this week's episode of Hit Play Not Pause - Running into Your Best Midlife

Feisty 40+ is written by Selene Yeager. Edited by Maya Smith. Ads by Ella Hnatyshyn

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