Background: Ischemic coronary events relate to qualitative changes in plaque characteristics. Epidemiological data on qualitative aspects of the coronary atherosclerotic process (e.g. plaque progression and destabilization) is missing. Objective: to qualitatively map the epidemiology of atherosclerosis burden in a representative cohort of deceased individuals Methods: this is a systematic, qualitative analysis of atherosclerotic burden in the proximal left coronary artery (LCA) segment of 695 tissue donors (median age 54, range 11-65 years). Based on the cause of death, donors were dichotomized into a non-cardiovascular (non-CVD group) and a cardiovascular disease (CVD) group. Consecutive, 5 mm LCA segments were Movat stained, and the atherosclerotic burden for each segment qualitatively graded (revised AHA-classification). Results: non-CVD and CVD groups show rapid acceleration of atherosclerosis severity after the age of 40; resulting in an almost endemic presence of advanced atherosclerosis in men and women over 40 respectively 50 years. In fact, only 19% of the non-CVD and 6% of the CVD donors over 40 presented with a normal LCA or non-progressive lesion type. The consolidated fibrous calcified plaque (FCP) dominated in both non-CVD and CVD donors over 40. Estimates of atherosclerosis load (i.e. average lesion grade, proportion of FCPs, and average number of FCPs per cross-section were all higher in the CVD group (P<1.10 -16 , P<0.0001 and P<0.05 respectively) Conclusions: advanced atherosclerotic disease is endemic in individuals over 40. Dominance of FCP lesions and the higher disease load in CVD donors imply that the atherosclerotic process is repetitive. Abundance of FCPs suggest that complications of plaque rupture are stochastic. This study was in part funded by the European Commission (Cartardis, FP7 HEALTH.2013.2.4.2-1).