Purvi Parwani explains the need for sex specific thresholds for coronary artery disease

As coronary CT angiography (CCTA) becomes increasingly important in assessing coronary artery disease (CAD), growing evidence suggests that applying the same thresholds to men and women may not fully capture differences in disease biology and risk.

Purvi Parwani, MD, MPH, a cardiologist, assistant professor of medicine and director of the Women’s Heart Health Clinic at Loma Linda University Health, discussed the emerging evidence around sex-specific thresholds for coronary plaque, stenosis and fractional flow reserve derived from CT (FFR-CT) during the 2026 Society of Cardiovascular Computed Tomography (SCCT) meeting. She shared some of takeaways with Cardiovascular Business in the above video interview.

Parwani said data from the CONFIRM 2 and PROMISE trials have shown that women generally have a lower overall plaque burden than men. However, after menopause, plaque burden increases. More importantly, when women have a similar degree of coronary stenosis as men, the plaque may carry greater risk.

This all raises the question of whether CCTA measures should have different thresholds for women.

FFR-CT presents another potential area for reconsideration. Data from the ADVANCE registry have suggested that women with FFR-CT values between 0.75 and 0.80, the commonly recognized gray zone, were less likely to have obstructive disease and often do not need revascularization. Parwani said a better cutoff for considering revacdularization might be at values below 0.75.