Study Uncovers Early Prevalence of Silent Atherosclerosis in Young Adults

A recent large-scale study has compellingly indicated that atherosclerosis—a condition characterized by the buildup of plaque in arteries—often afflicts young adults long before they exhibit any symptoms. This research highlights a notable prevalence of the disease among individuals who are seemingly healthy, marking a potential shift in how we approach cardiovascular health.

The investigation, led by Professor Henning Bundgaard from Rigshospitalet in Copenhagen and Dr. Borja Ibáñez from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Spain, analyzed data from over 16,000 participants. Shockingly, 57.1% of individuals without prior cardiovascular diagnoses were found to have atherosclerotic plaques. This research was presented during the ESC Congress 2026 and concurrently published in The New England Journal of Medicine.

Study Overview and Ambitions

The findings emerge from the REACT project, a pioneering effort aimed at understanding the silent progression of atherosclerosis throughout adulthood. Funded by the Novo Nordisk Foundation, this ambitious study aims to redefine cardiovascular prevention through enhanced precision medicine approaches. Professor Bundgaard encapsulated the vision of REACT, aiming to improve early identification of atherosclerosis and move towards personalized preventative strategies.

The initial phase of the study, known as REACT-DETECT, began in 2024 and encompasses participants aged 18 to 70 across Denmark and Spain. Researchers employed advanced imaging techniques to detect plaques in three primary vascular regions: the carotid arteries in the neck, the femoral arteries in the legs, and the coronary arteries that supply the heart.

Key Findings on Atherosclerosis Prevalence

One of the study's most striking findings is the early onset of atherosclerosis. Approximately 1 in 13 participants aged 18 to 29 displayed indicators of the condition in at least one artery. Notably, the prevalence sharply increased with age; among participants aged 60 to 70, nearly 90% showed signs of atherosclerosis.

Furthermore, a significant correlation emerged: participants with coronary artery plaques often exhibited plaques in either the carotid or femoral arteries. This overlap suggests that noninvasive imaging methods such as ultrasounds could become the mainstay for early detection, potentially enhancing screening processes substantially.

Gender Differences and Implications for Screening

Intriguingly, the data also shed light on varying patterns of plaque development between genders. Men tended to present signs of atherosclerosis a decade earlier than women, with women experiencing a more pronounced increase in prevalence during the ages of 40 to 60, coinciding broadly with menopause. These trends underscore the necessity for tailored cardiovascular prevention strategies that consider both sex and life stage.

Traditional cardiovascular risk assessments, which often rely on metrics like blood pressure and cholesterol levels, failed to identify a significant amount of individuals who already had silent atherosclerosis. This raises the alarming prospect that conventional methods could overlook those at risk, presenting a case for a paradigm shift to a direct imaging-based assessment model.

Rethinking Cardiovascular Prevention

Dr. Ibáñez remarked on the transformative potential of transitioning from indirect risk factors to direct detection of atherosclerosis, emphasizing that such an approach could enable timely interventions that extend beyond current standards. The study challenges the status quo, suggesting that the future of cardiovascular health must incorporate searching for early-stage disease markers rather than estimating risk based on traditional metrics.

With the groundwork laid, the second phase of REACT (REACT-PROTECT), targeted for 2027 to 2032, aims to assess whether this imaging-guided prevention can effectively combat the advancement of atherosclerosis and its resultant cardiovascular events. This critical next step will involve a randomized clinical trial evaluating the efficacy of early intervention against traditional methods.

Global Expansion and Future Directions

The REACT study is already looking beyond Europe, establishing partnerships with research entities in countries like India, Singapore, Tanzania, and Mexico to validate findings across diverse populations. This broader scope is vital for understanding the universality of the observed patterns in cardiovascular health.

Building on prior findings from the PESA-CNIC-Santander study, which revealed the presence of atherosclerosis in middle-aged adults, REACT targets younger demographics to trace the disease's trajectory from its initial emergence. Dr. Valentin Fuster, director of CNIC and a key contributor to both studies, remarked on the importance of early intervention in potentially halting or even reversing the condition's progression.

The implications of these findings could significantly alter existing cardiovascular intervention strategies. By leveraging advanced imaging technologies and maintaining a focus on early disease detection, there’s a strong potential to enhance personalized treatment plans and ultimately reduce the global impact of cardiovascular diseases.

For further details, you can access more information on the study's implications here.