Silent Artery Plaque Shows Up in 1 in 13 Adults Under 30

Keypoints:

• Imaging of 16,808 adults found plaque in 57.1% of people with no symptoms
• About 1 in 13 adults aged 18 to 29 already had atherosclerosis
• Prevalence reached 9 in 10 among those aged 60 to 70
• Standard risk scores missed most people with silent plaque
• Further clinical trials are needed before screening changes

Researchers recruited 16,808 people aged 18 to 70 in Denmark and Spain, none with a known history of atherosclerotic cardiovascular disease. Imaging found plaque in 57.1% of them. The results were presented in a Hot Line session at the European Society of Cardiology Congress 2026 and published at the same time in The New England Journal of Medicine. The paper appeared on 29 August.

The findings come from the first phase of the REACT study, which the authors describe as the most complete atlas of silent atherosclerosis across body regions, ages and sexes. Advanced imaging covered the carotid, femoral and coronary arteries. Researchers also analysed risk factors, blood biomarkers, omics samples and retinal images.

Plaques appeared early. About 1 in 13 people aged 18 to 29 had atherosclerosis in at least one artery, and the share rose to 9 in 10 by ages 60 to 70. Most participants with plaque in the coronary arteries also had it in the carotid or femoral arteries. Experts say atherosclerosis drives most cardiovascular deaths worldwide.

The pattern differs by sex. Disease appears earlier in men. In women, the steepest rise comes between ages 40 and 60, broadly overlapping the menopausal transition.

The sharpest finding concerns risk scores. Standard scores built on blood pressure, cholesterol and lifestyle missed most people who already had silent atherosclerosis, especially younger adults. One researcher noted that these scores estimate risk rather than detect the plaque itself, so chances to prevent heart events may be missed. A person can receive a reassuring estimate even when imaging shows plaque has started to form.

Researchers believe portable ultrasound could eventually identify hidden plaque earlier, but further clinical trials are needed. The next phase of the study will test whether imaging actually saves lives. For now, a reassuring risk score and a clear artery scan are not the same thing.