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This editorial refers to ‘Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study’, by Q. van den Bouwhuijsen et al. doi:10.1093/eurheartj/ehr227 .Atherosclerosis and its clinical sequelae are responsible for coronary artery disease, cerebrovascular complications, and peripheral arterial disease, a leading cause of mortality and morbidity in society.1 At the heart of the atherosclerotic disease cascade is the atherosclerotic plaque. For many years, pathology and post-mortem studies were the only method to evaluate the manifestation of atherosclerosis. The vulnerability of atherosclerotic plaques to rupture and cause cardiovascular and cerebrovascular events has long been associated with the presence of a thin fibrous cap with a large lipid core, endothelial denudation with platelet aggregation, presence of active inflammation, calcification, intraplaque haemorrhage, endothelial dysfunction, outward remodelling, and the …

The time has come for clinical cardiovascular trials with plaque characterization as an endpoint