Rupture of the atherosclerotic plaque that grows in arteries leads to the death of more than a quarter of humanity via heart attack and stroke. It is the single largest cause of human mortality. Imaging approaches for characterizing size and composition of atherosclerotic plaques have improved immensely over the past twenty years, but remain expensive enough in clinical practice to ensure they are used far less often then they might be. The average older individual in wealthier parts of the world may know that he or she has plaque, has been imaged within the past few years, but is unlikely to keep apace of how exactly that plaque is changing. As researchers note here, plaque doesn't just grow over time, it quietly changes composition to form more dangerous, unstable structures.
Atherosclerotic plaques are accumulations of fat, cholesterol, and other substances in the arteries, and over time these plaques can calcify. The degree of calcification is thought to promote plaque stability, which then potentially reduces the risk of possible rupture. Ruptured plaques can lead to the formation of a blood clot and possible stroke. "It is important to remember that plaques that don't yet cause symptoms can rapidly evolve in ways that make them more dangerous. 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."
For the study, researchers followed 802 patients from the Rotterdam Study - an ongoing large-scale, population-based study - aged 45 years and older with subclinical carotid artery atherosclerosis. Baseline MRIs of carotid plaque compositions were conducted and then repeated after six years. All participants were in pre-symptomatic stages of their disease.
Over the course of the research, plaques became more complex, developing multiple components such as calcification, bleeding, and fatty deposits. Changes towards more complex plaque composition were more common in men than in women. The study showed that compared to plaques without calcification, plaques that already had calcification were twice as likely to develop internal bleeding, which is a key indicator of plaque vulnerability and potential rupture. The researchers also did a simulation to predict plaque evolution beyond the six years. A simulated 30-year evolution showed that more than half of the participants who had single component plaques would develop into complex multicomponent plaques by the age of 70. "Even if there are no symptoms, early signs of plaque in your carotid arteries can quietly become more dangerous over time."
Link: https://www.rsna.org/news/2025/june/carotid-plaque-may-pose-danger
View the full article at FightAging
