CAROTID plaque composition varies across some ethnic groups and appears to be influenced by cardiovascular risk factors present in midlife, according to an MRI study of a multi-ethnic population cohort.
Moroccan participants had a lower prevalence of carotid plaque calcifications, while no differences in plaque component prevalence were observed between Dutch and South-Asian Surinamese participants.
Hypertension and smoking were also strongly linked to plaque characteristics detected later in life, highlighting opportunities for more personalised cardiovascular disease (CVD) prevention strategies.
CVD is a leading cause of morbidity and mortality, and atherosclerotic plaques in the carotid arteries can increase the risk of cardiovascular events. Beyond the presence of plaque, its composition may provide additional insight into future risk. Lipid-rich necrotic core (LRNC) and intraplaque haemorrhage (IPH) are considered markers of plaque vulnerability, whereas calcification may indicate more stable plaques.
Evidence linking cardiovascular risk factors in midlife to carotid plaque composition has been limited, particularly in ethnically diverse populations, with most previous studies focusing on older or symptomatic individuals of predominantly White European ancestry.
Smoking and Hypertension Linked to Plaque Components
Researchers used 3-T MRI to assess the carotid arteries of 356 Dutch, South-Asian Surinamese and Moroccan participants from the HELIUS study. At baseline, participants had a median age of 54 years, 42.1% were women, and the median interval between cardiovascular risk factor assessment and MRI was 8.4 years.
Calcifications were present in 62.6% of participants, LRNC in 21.3% and IPH in 3.9%. Hypertension was linked to a fourfold greater likelihood of calcifications (odds ratio [OR] 4.02; 95% confidence interval [CI] 1.59–10.12). Smoking was linked to both calcifications (OR 4.94; 95% CI 1.79–13.62) and LRNC (OR 2.88; 95% CI 1.30–6.40).
Initial associations between diabetes or a history of CVD and calcifications were attenuated after adjustment for other cardiovascular risk factors. No significant associations were identified for IPH, although the authors noted that its low prevalence limited the statistical power of the analysis.
Findings May Help Guide Targeted Prevention
The researchers concluded that unfavourable cardiovascular risk profiles in midlife were linked to a higher prevalence of carotid plaque components later in life, with ethnic differences in their prevalence. They suggest the findings opportunities for more personalised prevention strategies to reduce future CVD risk.
The study’s strengths included the use of high-resolution 3-T MRI and the inclusion of a relatively young, multi-ethnic cohort. However, the absence of gadolinium-enhanced MRI sequences may have reduced the accuracy of LRNC detection and prevented assessment of other plaque characteristics. The authors also cautioned that the low prevalence of IPH limited the analysis for that outcome, while the 8.4-year interval between risk factor assessment and imaging may have resulted in changes to participants’ cardiovascular risk profiles over time.
Reference
Vriend EMC et al. Cardiovascular risk factors and carotid plaque components in a multi-ethnic cohort using 3 Tesla MRI: the HELIUS study. Eur Radiol. 2026;DOI:10.1007/s00330-026-12713-2.
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