Cardiovascular risk factors and carotid plaque components in a multi-ethnic cohort using 3 Tesla MRI: the HELIUS study

Objective: Carotid plaque composition, including calcifications, lipid-rich necrotic core (LRNC), and intraplaque haemorrhage (IPH), is associated with an increased risk of cardiovascular disease (CVD). Its association with cardiovascular risk factors remains unclear, particularly in midlife and across ethnic groups. We examined the relation between cardiovascular risk factors and carotid plaque components using MRI. Materials and methods: We conducted 3-T MRI of the carotid arteries in 356 Dutch, South-Asian Surinamese, and Moroccan participants from the HELIUS study. Median follow-up time between the cardiovascular risk factor visit and MRI was 8.4 years. Multivariable logistic mixed regression models assessed associations between cardiovascular risk factors and plaque components Results: At baseline, participants had a median age of 54.0 years [IQR: 48.0–59.0] with 42.1% women. Plaque calcifications, LRNC, and IPH were present in 62.6%, 21.3%, and 3.9% of participants, respectively. Hypertension was strongly associated with calcifications (OR 4.02, 95% CI: 1.59–10.12), while smoking was both related to the presence of calcifications (OR 4.94, 95% CI: 1.79–13.62) and LRNC (OR 2.88, 95% CI: 1.30–6.40). The significant associations between both history of CVD and diabetes with calcifications were attenuated after adjusting for other risk factors. No significant associations were found for IPH, likely due to its low prevalence. There were no differences in plaque component prevalence between South-Asian Surinamese and Dutch, while Moroccans had a lower prevalence of calcifications. Conclusions: Unfavourable cardiovascular risk profiles in midlife were associated with an increased prevalence of carotid plaque components later in life, with ethnic differences in their prevalence. Key Points: Question There is limited understanding of how cardiovascular risk factors in midlife are associated with carotid plaque components across ethnicities, hampering targeted prevention of CVD. Findings Hypertension and smoking were strongly associated with carotid plaque calcifications; smoking was associated with LRNCs, while for IPH, no associations were found. Clinical relevance Unfavourable cardiovascular risk profiles in midlife increase the prevalence of carotid plaque components later in life, with ethnic differences in their prevalence, highlighting opportunities for personalised, targeted prevention strategies to reduce CVD.