Aims Components of carotid atherosclerotic plaque such as intraplaque haemorrhage and lipid core are important determinants of plaque progression and destabilization. The association between plaque components and risk factors for cardiovascular disease is not well studied. Methods and results Participants from the population-based Rotterdam Study with carotid wall thickening on ultrasound (n = 1006) underwent high-resolution magnetic resonance imaging for carotid plaque characterization. Maximum wall thickening, the degree of stenosis, and the presence of intraplaque haemorrhage, lipid core, and calcification were assessed in both carotid arteries and their associations with cardiovascular risk factors were investigated. Intraplaque haemorrhage and lipid core were present in almost 25% of plaques, respectively, and occurred simultaneously in 9% of plaques. In men, intraplaque haemorrhage and lipid core were more prevalent compared with women (28.8 vs. 18.3 and 28.9 vs. 21.7%, respectively). Intraplaque haemorrhage occurred more frequently at older age [odds ratio (OR) per 10 years 1.8, 95% confidence interval 1.6–2.1], in men (OR 2.2, 1.7–2.9), in persons with hypertension (multivariate adjusted OR 1.4, 1.1–1.8), and in current smokers (multivariate adjusted OR 1.6, 1.2–2.3). Men (OR 1.5, 1.2–1.9) and subjects with hypercholesterolaemia (multivariate adjusted OR 1.4, 1.1–1.7) more often exhibited a lipid core. Conclusion In subjects from the general population with carotid wall thickening, intraplaque haemorrhage and lipid core—both considered indicators of unstable plaque—are highly frequent and more prevalent in men compared with women. Furthermore, different risk factors are associated with these plaque components: hypertension and current smoking were risk factors for the presence of intraplaque haemorrhage, and hypercholesterolaemia was the only risk factor for lipid core presence.
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