Study finds silent arterial plaque in 57% of adults and one in 13 young people

Early arterial damage in young adults

A large-scale medical study presented on 29 August 2026 at the European Society of Cardiology Congress in Munich and published in The New England Journal of Medicine found that silent atherosclerosis develops far earlier in life than previously established. The REACT study, coordinated by the National Center for Cardiovascular Research (CNIC) in Madrid and Rigshospitalet in Copenhagen, examined 16,808 healthy participants aged 18 to 70 across Spain and Denmark who had no history of heart attack or stroke. Researchers found that one in 13 participants aged 18 to 29 (7.6%) already had arterial plaque buildups in their bodies without experiencing any symptoms.

Borja Ibáñez, scientific director of CNIC, described the findings among young participants during the presentation.

It is alarming that, as we have seen, almost 9% of the men analysed of that age and practically 7% of young women present silent atherosclerosis. In general we have seen percentages of affected people much higher than previously thought.

Scope and demographic patterns

Across the full cohort of adults aged 18 to 70, arterial plaque was detected in 57.1% of participants. The prevalence increased steadily with age, reaching 90% among adults aged 60 to 70. The study revealed notable variations between sexes in both timing and prevalence. Men showed an overall prevalence of 63.4%, compared to 50.9% among women. Furthermore, arterial plaques appeared five to ten years earlier in men than in women. Among participants younger than 40, plaque was present in about one in three men and one in five women. For those aged 40 to 50, the proportion rose to two thirds of men and nearly half of women, with female plaque accumulation accelerating between ages 40 and 60 alongside menopause.

Imaging methods and reversibility

To identify silent plaques, the researchers used non-invasive 3D ultrasound on the carotid arteries in the neck and the femoral arteries in the groin, alongside computed tomography angiography on the coronary arteries of the heart. While coronary angiography is more costly and invasive, the ultrasound examinations of peripheral arteries proved effective in identifying systemic plaque accumulation. Atherosclerosis occurs when fat, cholesterol, and inflammatory cells build up inside arterial walls, progressively narrowing blood vessels and causing the majority of heart attacks and strokes. Earlier research conducted by the CNIC demonstrated that atherosclerotic damage is reversible when detected and treated in its early stages before extensive arterial calcification takes place.

Proposed reforms in preventive care

Cardiovascular diseases cause approximately 20 million deaths globally each year, accounting for nearly one third of worldwide mortality. The World Health Organization and the World Heart Federation estimate that up to 80% of premature heart attacks and strokes could be prevented through timely interventions on risk factors. The research team argues that clinical guidelines should shift away from solely calculating statistical risk based on traditional factors such as blood pressure, smoking, and blood cholesterol. Instead, the authors recommend using early ultrasound screening to detect physical plaques directly, beginning before age 30, and initiating lifestyle changes or pharmacological treatment for cholesterol and blood pressure when diet and exercise prove insufficient.

Today atherosclerosis is diagnosed and treated when it is already very advanced. What the results of this work show is that we have to move toward a new way of preventing cardiovascular disease.