Prevalence of Carotid Atherosclerosis in Adult Populations in Europe and North America (USA, Canada): A Systematic Review of Population-Based Studies (2015–2025)

Backgrounds: Carotid atherosclerotic plaques (CAPs) are a reliable marker of systemic atherosclerosis and a predictor of cardiovascular events. Despite advances in prevention, the prevalence of CAPs in high-income regions remains uncertain due to heterogeneity in imaging definitions, study designs, and populations. We strived to provide an updated meta-analysis of population-based studies conducted in Europe and North America between 2015 and 2025, estimating the prevalence of CAPs in general populations. Methods: Following the PRISMA 2020 guidelines, PubMed and Web of Science were searched for original studies. Eligible studies reported CAPs prevalence in adult general populations using ultrasonography, computed tomography angiography, and magnetic resonance imaging. Pooled prevalence was calculated using a random-effects meta-analysis of proportions, and heterogeneity was assessed using I² and τ² statistics. Subgroup and meta-regression analyses explored associations with age and comorbidities. Results: A total of 80 studies comprising 177,196 participants were included. The pooled prevalence of CAPs was 39.8% (95% CI 32.6–47.5%) under a random-effects model with substantial heterogeneity (I² = 99.6%). The prevalence of CAPs increased with age, exceeding 59% among individuals aged over 70 years. High-risk populations, particularly those with T2DM, exhibited a prevalence exceeding 50%. Conclusions: CAPs are present in approximately 40% of adults in Europe and North America, with prevalence strongly driven by age and comorbidities. Despite therapeutic advances, the prevalence of CAPs has not declined, reflecting the growing impact of population aging and comorbidities. Standardized imaging definitions, longitudinal outcome linkage, and pragmatic prevention strategies are needed to translate CAPs detection into reduced cardiovascular events.