Carotid plaque burden in the adult Polish urban population and its association with body fat distribution

Introduction: Carotid plaques (CP) reflect systemic atherosclerotic burden and may predict cardiovascular (CV) events.Objectives: The aim of the study was to assess CP burden in a general adult urban population and its associations with fat distribution with adjustment for known CV risk factors.Patients and methods: Overall, 3321 participants from the Bialystok PLUS study (Poland) with a complete carotid ultrasound examination and clinical dataset were included, with a median (IQR) age of 49.0 (37.0-62.0)years.Plaques were assessed on ultrasound of 8 extracranial carotid segments.CP presence was defined as at least one plaque-positive segment, and CP burden was quantified as the number of plaque-positive segments across both sides (range, 0-8).Dual-energy X-ray absorptiometry was used to assess body composition.Results: Most participants had no CP (60.1%), whereas CP in 1, 2, 3, 4, and ≥5 segments were observed in 14.1%, 14.8%, 6.0%, 3.3%, and 1.6% of participants, respectively.Plaques were unevenly distributed across carotid segments, clustering at the bifurcation (right 30.1%, left 30.0%).A more central fat pattern was associated with a higher CP burden in women, whereas a more peripheral gynoid fat distribution was associated with a lower burden in men.After adjustment for selected CV risk factors, fat-distribution measures showed modest associations with CP burden in sex-stratified analyses.However, formal interaction tests did not provide statistically significant evidence of heterogeneity by sex.Conclusions: Age and established CV risk factors were the primary determinants of CP burden; however, selected fat-distribution measures showed additional but modest covariate-adjusted associations.(Google LLC, Mountain View, California, United States; accessed May 2026).AI-assisted tools were not used to perform data analyses, generate references, independently interpret the results, or formulate scientific conclusions.All AI-assisted edits and visual materials were critically reviewed and verified by the authors, who take full responsibility for the accuracy, integrity, originality, and final content of the manuscript.