Berry JD, Mehta A, Lin K, et al. - Among 440 Chicago Healthy Aging Study participants, researchers examined the link of baseline risk factors (RF) status with carotid atherosclerosis (overall mean carotid wall thickness and lipid-rich necrotic core) at follow-up, using multi-contrast carotid magnetic resonance imaging. The participants were categorized into 4 groups: low-risk, 0 high RF but some RF unfavorable (≥ 1 RF above low-risk threshold but below high-risk threshold), 1 high RF (total cholesterol ≥ 240 mg/dL or treated, blood pressure ≥ 140/90 or treated, diabetes mellitus, or smoking), and 2 or more high RF. They found higher carotid wall thickness and lipid-rich necrotic core prevalence (30%) in relation to two or more high RF status vs low-risk group. In models adjusted for baseline RF and demographics, higher carotid wall thickness and higher lipid-rich necrotic core prevalence at older age were observed in correlation with each increment in baseline RF status. Overall, a link of RF status in young adulthood with the burden and quality of carotid atherosclerosis in older age was shown, which indicates that possibly a lower burden of quantitative and qualitative features of atherosclerotic plaque be involved in the mediation of the decades-long protective influence of low-risk status.