Introduction: Echolucent plaques have high lipid contents and are related to a higher cardiovascular risk. Studies relating echolucency to cardiovascular risk in early stages of atherosclerosis are limited. We studied the relation between cardiovascular risk factors and the echolucency of the carotid intima–media thickness (CIMT) in low-risk individuals.

Methods: Data were used from the METEOR (Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin) study. In this post-hoc analysis, duplicate baseline ultrasound images from the far wall of the left and right common carotid arteries were used for evaluation of the echolucency of the CIMT, measured by grey-scale median (GSM), scale: 0–256. Low GSM values reflect echolucent, lipid-rich structures, whereas high values reflect echogenic structures. The relations between GSM and cardiovascular risk factors were evaluated with linear regression models.

Results: Baseline GSM was 83.96 (standard deviation: 29.40). Lower GSM of the CIMT was associated with older age, high body mass index (BMI), and low levels of high-density lipoprotein cholesterol (HDL-C) (beta, 95% confidence interval [CI]: −4.49 [−6.50;−2.49], −4.51 [−6.43;−2.60], and 2.45, [0.47;4.42], respectively). Thickness of the common CIMT was inversely related to GSM of the CIMT (beta −3.94 [−1.98;−5.89]).

Conclusion: Older age, high BMI, and low levels of HDL-C are related to echolucency of the CIMT, reflecting high lipid levels in the arterial wall. Hence, echolucency of the CIMT may be used as marker for cardiovascular risk profile that covers more than thickness alone.