{"product_id":"silent-atherosclerosis-new-research-shows-hidden-artery-plaque-is-common-starts-young-and-grows-steadily-with-age","title":"Silent Atherosclerosis: New Research Shows Hidden Artery Plaque Is Common, Starts Young, and Grows Steadily With Age","description":"\u003cp\u003eA major new study from Denmark and Spain reveals that silent atherosclerosis—fatty plaque buildup inside artery walls that causes no symptoms—is far more common across adult life than many people realize. Among 16,808 adults aged 18 to 70 with no known heart or vascular disease, 57.1% already had detectable plaque in at least one vascular territory. The disease was present even in the youngest participants, affecting 8.7% of men and 6.7% of women aged 18 to 29, and it became nearly universal with age: by ages 60 to 70, only 1.9% of men and 8.1% of women had no plaque in any examined artery. The findings, published in the \u003cem\u003eNew England Journal of Medicine\u003c\/em\u003e, provide the first detailed age- and sex-specific picture of when hidden atherosclerosis appears, where it collects, and how quickly it grows across adult life.\u003c\/p\u003e\n\n\u003ch1\u003eSilent Atherosclerosis: New Research Shows Hidden Artery Plaque Is Common, Starts Young, and Grows Steadily With Age\u003c\/h1\u003e\n\n\u003ch2 id=\"toc\"\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#intro\"\u003eWhat Is Silent Atherosclerosis and Why Does This Study Matter?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: What Researchers Already Knew\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#participants\"\u003eWho Took Part in the Study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#prevalence\"\u003eKey Finding: More Than Half of Adults Have Silent Atherosclerosis\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#sex-differences\"\u003eMen and Women Follow Different Timelines\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#territories\"\u003eWhere Plaque Collects: Neck, Legs, and Heart Arteries\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eWhat This Means for Patients and Doctors\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations: What This Research Could Not Show\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn a study of 13,186 adults with no known heart disease, 57.1% had silent atherosclerosis in at least one vascular territory.\u003c\/li\u003e\n\u003cli\u003eSilent plaque was found even in adults aged 18–29: 8.7% of men and 6.7% of women had detectable plaque.\u003c\/li\u003e\n\u003cli\u003eCoronary calcium scans missed about half of coronary plaque in 30-to-39-year-olds with plaque because it was noncalcified.\u003c\/li\u003e\n\u003cli\u003eCoronary plaque was strongly linked to peripheral plaque: 82.0% of participants with coronary plaque also had peripheral artery plaque.\u003c\/li\u003e\n\u003cli\u003eThe REACT study was cross-sectional, so age patterns are inferred from different age groups, not from following individuals over time.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"intro\"\u003eWhat Is Silent Atherosclerosis and Why Does This Study Matter?\u003c\/h2\u003e\n\n\u003cp\u003eAtherosclerosis is the slow buildup of plaque—a mixture of cholesterol, fat, calcium, and inflammatory cells—inside the walls of arteries. Over time, plaque can narrow arteries, limit blood flow, or rupture and trigger a blood clot. That process underlies the world's leading causes of illness and death: coronary heart disease, ischemic stroke, peripheral artery disease, and sudden cardiac death.\u003c\/p\u003e\n\n\u003cp\u003eWhen plaque accumulates without causing symptoms, doctors call it \u003cstrong\u003esilent atherosclerosis\u003c\/strong\u003e. Many people live with it for decades before a heart attack or stroke is the first signal that anything was wrong. The word \"silent\" is what makes this condition so challenging.\u003c\/p\u003e\n\n\u003cp\u003eModern prevention strategies are largely driven by risk calculators that estimate a person's chance of having an event in the next decade. Those calculators use factors like age, blood pressure, and cholesterol. They do not show whether atherosclerosis is actually present, where it sits, or how much plaque has already formed.\u003c\/p\u003e\n\n\u003cp\u003eThis distinction matters because plaque is often present years before any risk calculator would flag a person as high risk. The REACT study, reported in the \u003cem\u003eNew England Journal of Medicine\u003c\/em\u003e, was designed to answer a basic but crucial set of questions: When does silent atherosclerosis begin? How common is it at each stage of adult life? And where in the body does it first appear?\u003c\/p\u003e\n\n\u003ch2 id=\"background\"\u003eBackground: What Researchers Already Knew\u003c\/h2\u003e\n\n\u003cp\u003eImaging studies in older adults have consistently shown that silent atherosclerosis is common. Using techniques such as coronary-artery calcium scoring, coronary CT angiography (a special X-ray scan of the heart's arteries), and carotid or femoral ultrasound, previous studies detected silent atherosclerosis in roughly 40% to 80% of middle-aged and older participants.\u003c\/p\u003e\n\n\u003cp\u003eResearchers have also established that a larger plaque burden is linked to higher risks of future cardiovascular events and death. Longitudinal imaging studies—studies that scan the same people over time—have shown that plaque burden can grow as years pass. Known modifiable risk factors appear particularly important to plaque progression in younger adults.\u003c\/p\u003e\n\n\u003cp\u003eBut a major gap remained. Most large imaging cohorts enrolled people who were already middle-aged or older. Studies that included adults under 40 were often small, limited to selected groups, or based on indirect markers rather than direct measurement of plaque. The result: no clear age- and sex-specific map showing when atherosclerosis first appears, how it spreads through different arteries, or how it accumulates from early adulthood through later life.\u003c\/p\u003e\n\n\u003cp\u003eThe REACT Initiative was created to fill that gap.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eREACT is a multicenter prospective cohort study carried out in Denmark and Spain. A prospective cohort study follows a defined group of people forward in time to observe how a condition develops. In this case, the researchers enrolled adults and performed detailed imaging at baseline to document the presence and amount of silent atherosclerosis.\u003c\/p\u003e\n\n\u003cp\u003eThe study was designed by academic investigators and conducted according to the Declaration of Helsinki, an international set of ethical principles for medical research. Ethics committees in both Denmark and Spain approved the protocol. Every participant gave written informed consent, and each person was told their own individual imaging results. The study funder, the Novo Nordisk Foundation, had no role in the design, data collection, analysis, or reporting.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWho was eligible?\u003c\/strong\u003e Adults aged 18 to 70 were eligible if they had no history of established clinical atherosclerotic cardiovascular disease—such as a prior heart attack, ischemic stroke, or peripheral artery disease—and no previous coronary revascularization (a procedure like a stent or bypass to restore blood flow to the heart). Symptoms such as chest pain from angina or leg pain from claudication were not formal reasons for exclusion, as long as no disease had been formally diagnosed.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eHow were participants chosen?\u003c\/strong\u003e The enrollment plan called for roughly 2,000 participants in each of the youngest (18 to 29) and oldest (60 to 70) age groups, and roughly 4,000 in each of the middle groups (30 to 39, 40 to 49, and 50 to 59). Within each stratum, researchers aimed for balanced numbers of men and women and balanced recruitment from each country.\u003c\/p\u003e\n\n\u003cp\u003eThe two countries used different recruitment methods. In Denmark, participants were identified through stratified random sampling from the Civil Registration System, a national database. In Spain, participants volunteered in response to open public advertisement. This difference in recruitment is worth keeping in mind when interpreting results.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhat imaging was performed?\u003c\/strong\u003e Each participant underwent multimodal imaging of three arterial territories:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCarotid arteries\u003c\/strong\u003e (the arteries in the neck that supply the brain), assessed with three-dimensional vascular ultrasound\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFemoral arteries\u003c\/strong\u003e (the arteries in the groin and upper legs), also assessed with three-dimensional vascular ultrasound\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCoronary arteries\u003c\/strong\u003e (the arteries on the surface of the heart that feed the heart muscle), assessed with coronary CT angiography\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCoronary calcification—calcium deposits within plaque—was measured separately with noncontrast CT, and results were expressed as coronary-artery calcium scores in Agatston units, a standard measurement scale.\u003c\/p\u003e\n\n\u003cp\u003eResearchers also estimated traditional cardiovascular risk with the \u003cstrong\u003eSCORE2 framework\u003c\/strong\u003e (Systematic Coronary Risk Evaluation 2). SCORE2 predicts a person's 10-year risk of fatal and nonfatal cardiovascular disease for European adults aged 40 to 69. Higher scores indicate higher risk.\u003c\/p\u003e\n\n\u003cp\u003eFor statistical analysis, prevalence was calculated as the percentage of participants with at least one plaque in any examined territory. Age trajectories were estimated with cubic spline curves, a flexible statistical method that captures how a trend changes across age. Models were adjusted for country, sex, and age as appropriate. Results were reported as adjusted odds ratios with 95% confidence intervals (CI).\u003c\/p\u003e\n\n\u003cp\u003eThe researchers note that they made no statistical adjustment for multiplicity—that is, for the fact that many comparisons were made. The unadjusted confidence intervals should therefore be read as descriptive rather than as formal tests of hypotheses.\u003c\/p\u003e\n\n\u003ch2 id=\"participants\"\u003eWho Took Part in the Study\u003c\/h2\u003e\n\n\u003cp\u003eBetween November 2024 and June 2026, the study enrolled \u003cstrong\u003e16,808 adults\u003c\/strong\u003e. Just over half, 50.3%, were recruited in Spain, and 49.7% in Denmark. The mean age was 45 years, with a standard deviation of 12 years, and 51.4% of participants were women.\u003c\/p\u003e\n\n\u003cp\u003eImaging results were available for most participants: carotid imaging in 16,317 people, femoral imaging in 15,844, and coronary imaging in 14,140. Complete imaging of all three territories was obtained in 13,186 participants, and this group formed the primary analysis population for prevalence estimates.\u003c\/p\u003e\n\n\u003cp\u003eA broad range of clinical and laboratory measurements was collected at baseline, including blood pressure, lipid panels (cholesterol and triglycerides), body-mass index, glucose and HbA1c levels, C-reactive protein, smoking history, medication use, and family history of cardiovascular disease. The study population appeared representative of the general populations of Spain and Denmark.\u003c\/p\u003e\n\n\u003ch2 id=\"prevalence\"\u003eKey Finding: More Than Half of Adults Have Silent Atherosclerosis\u003c\/h2\u003e\n\n\u003cp\u003eThe headline result is striking. Among participants with complete imaging, \u003cstrong\u003e57.1% had silent atherosclerosis in at least one vascular territory\u003c\/strong\u003e (95% confidence interval, 56.3% to 58.0%).\u003c\/p\u003e\n\n\u003cp\u003eThe condition was significantly more common in men than in women:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMen:\u003c\/strong\u003e 63.4% had plaque (95% CI, 62.2% to 64.6%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eWomen:\u003c\/strong\u003e 50.9% had plaque (95% CI, 49.7% to 52.1%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAfter adjusting for age and other factors, women had an odds ratio of 0.44 for having silent atherosclerosis compared with men (95% CI, 0.40 to 0.48). In plain language: a woman's odds of having plaque were roughly 56% lower than a man's odds at the same age.\u003c\/p\u003e\n\n\u003cp\u003eSilent atherosclerosis was already detectable in the youngest adults. In the 18-to-29 age group:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e8.7% of men\u003c\/strong\u003e had plaque (95% CI, 6.7% to 11.1%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e6.7% of women\u003c\/strong\u003e had plaque (95% CI, 5.1% to 8.7%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eBy ages 30 to 39, the numbers climbed steeply:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e34.6% of men\u003c\/strong\u003e had plaque (95% CI, 32.2% to 37.0%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e21.3% of women\u003c\/strong\u003e had plaque (95% CI, 19.2% to 23.5%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe odds of having silent atherosclerosis rose dramatically with each decade of life. For every 10-year increase in age, the adjusted odds ratio was \u003cstrong\u003e4.52 for men\u003c\/strong\u003e (95% CI, 4.21 to 4.87) and \u003cstrong\u003e3.85 for women\u003c\/strong\u003e (95% CI, 3.61 to 4.12). This exponential pattern means that risk does not climb evenly year by year—it accelerates.\u003c\/p\u003e\n\n\u003cp\u003eBy the time participants reached ages 60 to 70, having \u003cem\u003eno\u003c\/em\u003e plaque at all was the exception rather than the rule. Only \u003cstrong\u003e1.9% of men\u003c\/strong\u003e (95% CI, 1.1% to 3.0%) and \u003cstrong\u003e8.1% of women\u003c\/strong\u003e (95% CI, 6.4% to 10.0%) had no detectable plaque in any examined territory.\u003c\/p\u003e\n\n\u003ch2 id=\"sex-differences\"\u003eMen and Women Follow Different Timelines\u003c\/h2\u003e\n\n\u003cp\u003eThe study revealed important differences in how atherosclerosis develops in each sex.\u003c\/p\u003e\n\n\u003cp\u003eIn men, prevalence began to climb noticeably starting in the 30-to-39 decade, and the curve started to flatten by midlife. In women, the steepest rise came later—after age 40. This delayed acceleration in women narrowed the gap between the sexes as age increased.\u003c\/p\u003e\n\n\u003cp\u003eBy ages 60 to 70, the difference between men and women had substantially closed, although women were still more likely than men to have completely clean arteries (8.1% versus 1.9%).\u003c\/p\u003e\n\n\u003cp\u003eThese patterns suggest that the biology of atherosclerosis, and probably the influence of hormonal changes around menopause, shifts the risk timeline for women. The results also emphasize that screening and prevention strategies cannot treat men and women as identical when it comes to vascular aging.\u003c\/p\u003e\n\n\u003ch2 id=\"territories\"\u003eWhere Plaque Collects: Neck, Legs, and Heart Arteries\u003c\/h2\u003e\n\n\u003cp\u003eThe REACT study offers a detailed picture of how plaque distributes across the body's major arterial territories.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eYoung people usually have peripheral disease.\u003c\/strong\u003e Among younger participants, silent atherosclerosis was most often found in the peripheral arteries—the carotid and femoral arteries—rather than in the coronary arteries that supply the heart. When plaque was present in younger adults, it was usually confined to a single vascular territory and most often detected in the carotid arteries.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCombined territory involvement grows with age.\u003c\/strong\u003e In older age groups, plaque in both the carotid and femoral arteries became more common, particularly in men. Atherosclerosis is not a disease that stays put; it tends to spread across arterial beds over time.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eIsolated coronary atherosclerosis was uncommon at every age.\u003c\/strong\u003e Plaque found only in the heart's arteries, with no plaque in the peripheral vessels, was rare in all age groups. It peaked at \u003cstrong\u003e9.3% of men\u003c\/strong\u003e (95% CI, 7.9% to 10.8%) and \u003cstrong\u003e5.0% of women\u003c\/strong\u003e (95% CI, 4.0% to 6.1%). This is a clinically useful finding: when atherosclerosis is present in the coronary arteries, it is very often accompanied by disease elsewhere in the vascular tree.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCoronary plaque severity and calcification both increased with age\u003c\/strong\u003e in men and women. But an important nuance emerged for younger adults: coronary plaque was frequently present even when no calcium could be detected on CT scanning. Among participants aged 30 to 39 who had coronary plaque, \u003cstrong\u003e41.8% of men\u003c\/strong\u003e (95% CI, 32.5% to 51.6%) and \u003cstrong\u003e48.4% of women\u003c\/strong\u003e (95% CI, 30.2% to 66.9%) had a coronary-artery calcium score of zero. This percentage declined with age, but noncalcified plaque was still observed in some adults aged 60 to 70.\u003c\/p\u003e\n\n\u003cp\u003eThat finding matters because coronary calcium scoring alone—a common screening test—would have missed roughly half of the coronary plaque in younger adults. Noncalcified (soft) plaque can still rupture and cause heart attacks, even though it is invisible to a calcium-only scan.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAtherosclerosis in different territories was strongly interrelated.\u003c\/strong\u003e Among participants who had coronary-artery plaque, \u003cstrong\u003e82.0%\u003c\/strong\u003e (95% CI, 80.7% to 83.2%) also had peripheral artery plaque. Among those without coronary plaque, only \u003cstrong\u003e41.5%\u003c\/strong\u003e (95% CI, 40.5% to 42.5%) had peripheral plaque.\u003c\/p\u003e\n\n\u003cp\u003eThe probability of having coronary atherosclerosis also rose steadily as peripheral plaque volume increased. Compared with the lowest quartile of peripheral plaque volume, participants in progressively higher quartiles had odds ratios of \u003cstrong\u003e1.32, 1.85, and 3.70\u003c\/strong\u003e for coronary atherosclerosis. In other words, the more plaque seen in the neck and leg arteries, the higher the chance that plaque also exists in the heart's arteries.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat This Means for Patients and Doctors\u003c\/h2\u003e\n\n\u003cp\u003eThe study's findings carry several practical messages.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSilent atherosclerosis is not an old person's disease.\u003c\/strong\u003e One in 11 men in their twenties already had plaque. Among people in their thirties, the figure was roughly one in three men and one in five women. Waiting until traditional risk scores suggest danger may mean waiting too long.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRisk calculators have blind spots.\u003c\/strong\u003e The study assessed how well conventional risk assessment identifies people with established silent atherosclerosis. It showed that a substantial burden of atherosclerosis exists in people whose traditional risk profiles might not prompt aggressive prevention. Importantly, the presence of silent atherosclerosis is associated with cardiovascular events and death independently of traditional risk factors, based on earlier research cited by the authors.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePeripheral arteries offer a window into the heart.\u003c\/strong\u003e Because isolated coronary atherosclerosis was uncommon, and because coronary plaque was strongly linked to peripheral plaque volume, ultrasound of the carotid and femoral arteries may serve as an accessible first step for detecting systemic atherosclerosis. Ultrasound does not involve radiation and is widely available.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCalcium scans can miss early disease.\u003c\/strong\u003e The high rate of noncalcified coronary plaque in younger adults suggests that a zero calcium score does not guarantee clean coronary arteries in that population. This is particularly relevant if calcium screening is being considered for adults under 40 or 45.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePrevention should be sex-aware.\u003c\/strong\u003e The later but steep rise in women suggests that regular risk assessment during the 40s and 50s is critical for women, even if earlier scans or risk scores were reassuring.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations: What This Research Could Not Show\u003c\/h2\u003e\n\n\u003cp\u003eThe REACT study is the largest of its kind, but it has limits that should be acknowledged.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCross-sectional design.\u003c\/strong\u003e All imaging and measurements were taken at a single time point. The study describes plaque prevalence at different ages, but it does not directly follow individuals over time. The age patterns are inferred by comparing different groups of people, not by watching the same people age. True progression rates require longitudinal follow-up, which the REACT team may provide in future reports.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCountry-specific recruitment differences.\u003c\/strong\u003e Danish participants were selected by random sampling from a national registry, while Spanish participants self-selected through public advertisement. Volunteers who respond to advertisements may be healthier or more health-conscious than the general population, which could affect prevalence estimates. The authors note the population appeared representative, but some selection bias is possible.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStatistical considerations.\u003c\/strong\u003e Confidence intervals were not adjusted for the multiple comparisons made in the study. The authors explicitly state that the intervals should be interpreted as descriptive, not as replacements for formal hypothesis testing.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eIncomplete imaging in some participants.\u003c\/strong\u003e Coronary imaging was available in 14,140 of the 16,808 enrolled participants, and complete three-territory imaging in 13,186. If the participants missing imaging differed systematically from those with complete imaging, prevalence estimates could be slightly affected.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDefinitions of \"no plaque.\"\u003c\/strong\u003e The finding that only 1.9% of men aged 60 to 70 had no plaque depends on the sensitivity of the imaging techniques used. It is possible that very small plaques below the detection threshold of ultrasound or CT were present but not counted.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhat the study does not prove.\u003c\/strong\u003e The study shows that plaque is present; it does not directly measure which participants will go on to have heart attacks or strokes. Atherosclerosis is a necessary precursor to many events, but not every plaque causes an event, and the study does not yet provide event-based outcomes for these participants.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on the REACT findings and the broader medical literature, patients can take practical steps:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not assume young and healthy means no plaque.\u003c\/strong\u003e The study found atherosclerosis in 8.7% of men and 6.7% of women in their twenties. Healthy lifestyles matter early, not just after a diagnosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow your numbers, but understand their limits.\u003c\/strong\u003e Blood pressure, cholesterol, blood sugar, and standard risk scores are essential tools, but the REACT study shows that a reassuring risk score does not rule out silent atherosclerosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk your doctor about vascular imaging if you have accumulated risk factors.\u003c\/strong\u003e The study found a strong link between peripheral plaque and coronary plaque. Carotid or femoral ultrasound, which is noninvasive and radiation-free, can reveal whether atherosclerosis is present years before a cardiac event.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not rely on a calcium scan alone if you are under 40.\u003c\/strong\u003e Among 30-to-39-year-olds with coronary plaque, roughly 42% to 48% had a coronary calcium score of zero. Noncalcified plaque is invisible to calcium-only screening. CT angiography with contrast, when clinically indicated, can detect both calcified and noncalcified plaque.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eWomen need continued vigilance after 40.\u003c\/strong\u003e The steepest rise in silent atherosclerosis for women occurred after age 40. A normal assessment in your thirties is not a reason to skip reassessment in your forties and fifties.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTreat modifiable risk factors seriously.\u003c\/strong\u003e The authors cite extensive prior evidence that modifiable risk factors—smoking, blood pressure, cholesterol, diabetes—drive plaque progression, particularly in younger people. Lowering those factors is the most direct way to slow or stop the disease that was so common in this study.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you already know you have plaque, view it as an opportunity.\u003c\/strong\u003e Silent atherosclerosis is a warning, but it is also a chance to act before symptoms or events occur. The very fact that this disease is detectable years in advance is what makes prevention possible.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eFuture reports from the REACT cohort, which follows participants over time, will help answer the next critical question: which patterns of silent atherosclerosis most strongly predict actual heart attacks, strokes, and death?\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat does it mean if I have 'silent atherosclerosis' and no symptoms?\u003c\/h3\u003e\n\u003cp\u003eIt means fatty plaque has built up inside your artery walls without causing symptoms. Over time, plaque can narrow arteries or rupture and trigger a heart attack or stroke. The REACT study found silent atherosclerosis in 57.1% of 13,186 adults with no known heart or vascular disease. It is detectable years before symptoms appear.\u003c\/p\u003e\n\u003ch3\u003eWhat does a coronary-artery calcium score of zero mean? Can I still have plaque?\u003c\/h3\u003e\n\u003cp\u003eA calcium score of zero means no calcified plaque was detected, but it does not rule out noncalcified soft plaque. In the REACT study, among 30-to-39-year-olds with coronary plaque, 41.8% of men and 48.4% of women had a calcium score of zero. This soft plaque can still rupture and cause heart attacks.\u003c\/p\u003e\n\u003ch3\u003eI am a woman over 40. Am I at risk for silent atherosclerosis even if my risk scores look normal?\u003c\/h3\u003e\n\u003cp\u003eYes. Women in the REACT study showed a steep rise in silent atherosclerosis after age 40. Overall, 50.9% of women had plaque compared with 63.4% of men. However, by ages 60–70, 8.1% of women still had clean arteries versus 1.9% of men. Women should not assume a normal assessment in their 30s means continued safety.\u003c\/p\u003e\n\u003ch3\u003eHow is silent atherosclerosis detected? What about ultrasound of the neck or leg arteries?\u003c\/h3\u003e\n\u003cp\u003eThe REACT study used three-dimensional vascular ultrasound of carotid and femoral arteries plus coronary CT angiography. Because isolated coronary plaque was uncommon and coronary plaque strongly linked to peripheral plaque, ultrasound of neck and leg arteries may serve as a first step. It is noninvasive, radiation-free, and widely available.\u003c\/p\u003e\n\u003ch3\u003eWhat practical steps should I take based on the REACT study findings?\u003c\/h3\u003e\n\u003cp\u003eDo not assume being young means no plaque. Know your blood pressure, cholesterol, blood sugar, and standard risk scores, but understand a reassuring score does not rule out silent atherosclerosis. Ask your doctor about vascular imaging if you have accumulated risk factors. Treat modifiable risk factors seriously, and if you have plaque, view it as an opportunity to act before symptoms occur.\u003c\/p\u003e\n\u003ch3\u003eI was just diagnosed with silent atherosclerosis on an ultrasound or CT scan. Should I get a second opinion?\u003c\/h3\u003e\n\u003cp\u003eSilent atherosclerosis is plaque without symptoms, and it is common: 57.1% of adults in the REACT study had it, including some people in their twenties. A second opinion is useful when your traditional risk score seems reassuring, because substantial plaque can exist despite normal risk profiles. If you are under 40, a calcium score of zero does not rule out noncalcified plaque; roughly 42–48% of 30-to-39-year-olds with coronary plaque had zero calcium. A second opinion can confirm the imaging finding and clarify whether additional testing or closer follow-up is warranted. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003eThis patient-friendly article is based on peer-reviewed research published in the \u003cem\u003eNew England Journal of Medicine\u003c\/em\u003e.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal title:\u003c\/strong\u003e Prevalence of Silent Atherosclerosis across Adult Life\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e H. Bundgaard, I. García-Lunar, K.F. Kofoed, R. Hasselbalch, C.N. Pérez-García, J.B. Kunkel, F.F. Stæger, F. Sánchez-Cabo, J.J. Fuster, V. Mass, J. Sánchez-González, M.V. Kragh, A.K. Ringgaard, J. Valls-Monzó, M.H.C. Pham, A. Devesa, M. Sejer, P. Sigvardsen, A. Quesada, C. Eberhard, A. García-Álvarez, L.M. Pehrson, Á. Navarro-Guzmán, S. Winther, M. Sørgaard, M. Gámez, M. Lundsgaard, C. Pérez-Herreras, R. Frikke-Schmidt, P.L. Sánchez, N. Eldrup, J. Torres-Macho, M. Bøttcher, V. Fuster, K.K. Iversen, and B. Ibanez, for the REACT Investigators\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e Published August 29, 2026, at NEJM.org. DOI: 10.1056\/NEJMoa2609059. Copyright © 2026 Massachusetts Medical Society.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c\/strong\u003e Novo Nordisk Foundation. ClinicalTrials.gov number: NCT06692127.\u003c\/p\u003e\n\u003cp\u003eThis translation preserves all numerical data, confidence intervals, and study findings from the original article. For medical decisions, consult a qualified healthcare professional and review the original publication.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47542002679964,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/de\/products\/silent-atherosclerosis-new-research-shows-hidden-artery-plaque-is-common-starts-young-and-grows-steadily-with-age","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}