Advanced vascular imaging has detected silent atherosclerosis in one in 13 adults aged 18 to 29 who have no known cardiovascular disease, according to researchers from Denmark and Spain who announced the findings on April 10, 2026.
The findings stem from the REACT study, an international project that enrolled 16,808 volunteers aged 18 to 70 across Denmark and Spain. Investigators evaluated carotid and femoral plaque using three-dimensional vascular ultrasonography, while assessing coronary atherosclerosis through computed tomography angiography and noncontrast coronary computed tomography.
Overall, 57.1 percent of participants who underwent a complete examination showed plaque in at least one examined vascular territory. Prevalence increased with age, starting at roughly one in 13 among adults under 30 and reaching about nine in 10 among individuals aged 60 to 70.
Among participants aged 18 to 29 without diagnosed cardiovascular disease, asymptomatic atherosclerosis appeared in 6.7 percent of women and 8.7 percent of men. In the 30 to 39 age group, plaques were recorded in 34.6 percent of men and 21.3 percent of women, according to the analysis.
Prevalence analysis used data from 13,186 participants who underwent a complete examination across three vascular territories.
Men developed plaque five to 10 years earlier than women. Overall, atherosclerosis was detected more often in men than in women at 63.4 percent versus 50.9 percent. For women, the steepest increase occurred between ages 40 and 60, a window that broadly overlaps with the menopausal transition.
This study shows that we can now go one step further and detect the disease directly before it causes a heart attack or stroke.
Dr. Borja Ibáñez, scientific director of Spain’s National Center for Cardiovascular Research
Younger participants typically exhibited plaque in peripheral arteries, particularly the carotid arteries, usually involving a single vascular territory. Combined carotid and femoral involvement became more frequent with advancing age.
Traditional cardiovascular risk assessment models identified only a fraction of participants who carried silent plaque. The Systematic Coronary Risk Evaluation 2 (SCORE2) model, which predicts 10-year cardiovascular risk in European adults aged 40 to 69, placed fewer than 2 percent of participants with detectable plaque into the high-risk category.
For decades, we have estimated cardiovascular risk using factors such as age, blood pressure and cholesterol,
Dr. Borja Ibáñez, scientific director of Spain’s National Center for Cardiovascular Research
Isolated coronary atherosclerosis remained uncommon across all age groups, affecting no more than 9.3 percent of men and 5.0 percent of women. Among participants aged 30 to 39 with coronary plaque, roughly four in ten men and five in ten women recorded a coronary artery calcium score of zero, demonstrating that a zero score does not rule out noncalcified coronary plaque in younger adults.
REACT shows that atherosclerosis can be detected decades before clinical manifestations appear and provides the most comprehensive atlas of the evolution of the disease across adult life,
Professor Henning Bundgaard
While noting that the presence of plaque does not mean an immediate cardiac event, Dr. Sirisha Vadali emphasized that it provides a chance to manage risk elements like tobacco use, lack of exercise, and unhealthy eating habits.
To safeguard cardiovascular health, specialists advise staying away from tobacco, remaining physically active, and consuming a diet abundant in fruits, vegetables, beans, whole grains, nuts, and fish, while keeping saturated fats and excessive sodium intake to a minimum.
Upcoming stages of the REACT trial will evaluate whether early identification and focused preventative interventions genuinely lower the rates of heart attacks and strokes over time, supplying vital information for forthcoming screening guidelines.