Ethnic differences in carotid bulb geometry between Asian and White populations

Background Carotid bifurcation geometry influences local hemodynamics and may contribute to plaque formation and carotid disease. Interethnic differences in carotid bulb geometry remain incompletely characterized. However, Asian populations are known to have less atherosclerosis burden in the extracranial carotid arteries compared to White populations. Methods In a cross-sectional study (2022–2025), 200 adults without relevant carotid stenosis were enrolled consecutively (100 White participants in Germany; 100 Asian participants in China). Carotid geometry was assessed bilaterally using predefined diameter ratios; Carotid bulb (CB)/Internal carotid artery (ICA) diameter was the prespecified primary outcome. Linear mixed-effects models accounted for within-subject correlation; adjusted models included age, sex, BMI, diabetes, hypertension, dyslipidemia, smoking, and atrial fibrillation. Results In unadjusted models, significant ethnic differences were observed across all primary geometry ratios. CB/ICA was lower in Asian versus White participants (EMM 1.57 vs. 1.68; p < 0.001). After adjustment, the CB/ICA difference remained robust (Asian minus White −0.09; 95% CI -0.14 to −0.04; p < 0.001). Additional adjusted differences were observed for CB/CCA, ICA/CCA, ECA/ICA, and outflow/inflow, whereas no significant difference persisted for ECA/CCA. Analyses of absolute diameters showed no significant interethnic difference in ICA diameter, while carotid bulb diameter was smaller in Asian participants. Conclusion Carotid bifurcation geometry differs between Asian and White adults independent of vascular risk factors. These anatomical differences may have implications for carotid hemodynamics and plaque formation across populations.