Silent artery plaques may appear in one in 13 adults before age 30

Key Points:

• An international study presented at ESC Congress 2026 and published in the New England Journal of Medicine reveals that 57.1% of over 16,000 asymptomatic adults aged 18–70 have silent atherosclerotic plaques, indicating the disease is more common and begins earlier than previously thought.
• The REACT study, led by experts from Denmark and Spain, uses advanced imaging to detect atherosclerosis in carotid, femoral, and coronary arteries, showing that even 1 in 13 young adults (18–29 years) have the disease, with prevalence increasing to 90% in those aged 60–70.
• Findings highlight sex differences, with men developing atherosclerosis earlier than women, while women show a sharp increase during menopausal transition; current cardiovascular risk scores fail to identify many individuals with silent disease.
• Researchers advocate for a new precision medicine approach to cardiovascular prevention, recommending noninvasive ultrasound screening of easier-to-examine arteries to detect atherosclerosis early and guide personalized interventions.
• The ongoing REACT study will continue through 2032, including a planned randomized trial to test imaging-guided prevention strategies, and is expanding globally to validate findings across diverse populations.