Study Reveals Increased Vulnerability of Men to Dynamic Carotid Plaque

A recent study conducted by Dutch researchers has revealed that men exhibit a greater susceptibility to dynamic carotid atherosclerotic plaque, which is associated with an increased risk of intraplaque hemorrhage (IPH). The findings, published in the journal Radiology on June 3, 2025, indicate that certain components within carotid plaques may interact in ways that heighten the risk of serious vascular events, especially among men.

Led by Dr. Daniel Bos, PhD, associate professor in epidemiology and radiology at Erasmus MC University Medical Center in Rotterdam, the study analyzed data from the long-term Rotterdam Study, which has been tracking health outcomes in residents aged 45 and older since its inception. The research team focused on MRI scans of carotid arteries, highlighting the importance of plaque composition over size in predicting the likelihood of ischemic stroke.

According to Dr. Bos, “Over the past decade, improvements in in vivo imaging techniques, especially MRI, have fueled the insight that atherosclerotic plaque components, as opposed to plaque size or luminal stenosis, are likely more important for determining the subsequent risk of ischemic stroke.”

The longitudinal study monitored 802 participants, with an average age of 68.5 years, who underwent MRI scans at two points: during an initial examination between October 2007 and November 2012 and again six years later. The results showed that plaques exhibiting calcification were twice as likely to develop internal bleeding compared to those without calcification, indicating a significant risk factor for vulnerability.

Statistical analysis revealed that 20.1% of plaques were free from calcification, lipid-rich necrotic cores, and other hazardous components, while 28.4% of plaques had two or more components. Interestingly, men were more prone to transition from simpler plaque types to more complex multicomponent forms with IPH, with 21% of male participants showing this evolution compared to 13% of females (p < 0.001).

Dr. Bos emphasized the clinical implications of these findings for stroke prevention strategies, stating, “One of the key findings of our work is that calcified plaques may not be as harmless as once thought, since these plaques were found to be at risk of intraplaque bleeding, which in itself is the most important cause of plaque rupture and subsequent stroke.” He advocates for ongoing monitoring of plaque development and proactive management of risk factors.

The study also simulated a 30-year evolution of plaque compositions, revealing that multicomponent plaques began representing 10% at age 55 and increased to over 50% after age 70, indicating a pressing need for age-specific preventive measures.

Despite the significant insights gained, the researchers acknowledged limitations in their study. The noncontrast MRI used could not accurately assess the fibrous cap of carotid plaques, an important component linked to plaque stability. Additionally, the qualitative assessment of plaque components did not account for volume or morphological characteristics, which could influence risk assessments.

The findings underscore the necessity of further longitudinal studies to explore the relationship between the morphologic characteristics of calcification and the risk of incident IPH. As the healthcare community seeks to enhance stroke prevention strategies, understanding the dynamic nature of carotid plaque composition will be crucial.

For further details, the complete study and supplementary information can be accessed in the latest issue of Radiology.