Heart disease is usually thought of as something that shows up in your 50s or 60s. A large new imaging study suggests the process behind it, the buildup of fatty plaque in the arteries, is already under way in a surprising number of younger adults who feel completely healthy.
The study, published October 1 in the New England Journal of Medicine, scanned the arteries of 16,808 adults aged 18 to 70 in Denmark and Spain. None had been diagnosed with cardiovascular disease. More than half of them had plaque anyway.
What the researchers did
The work is the first phase of a project called REACT, led by Spain’s National Center for Cardiovascular Research (CNIC) and Rigshospitalet in Copenhagen. Volunteers who were “apparently healthy” had imaging of three key artery areas: the carotid arteries in the neck, the femoral arteries in the legs and the coronary arteries that feed the heart. The team also collected standard risk factors and blood samples.
The condition they were looking for is atherosclerosis, a slow buildup of plaque inside artery walls. It often causes no symptoms for years. Over time it can narrow arteries or trigger a clot, which is how many heart attacks and strokes happen.
What they found
- 57.1% of participants had atherosclerotic plaque in at least one of the areas scanned.
- About 1 in 13 people aged 18 to 29 already had detectable plaque.
- The share rose steadily with age, reaching roughly 9 in 10 among people aged 60 to 70.
- Men tended to develop plaque 5 to 10 years earlier than women. In women, the sharpest rise came between ages 40 and 60, the years around menopause.
- People with plaque in the neck or leg arteries often had it in the heart’s arteries too.
One finding stood out to the researchers: SCORE2, a standard European tool that estimates heart risk from things like age, blood pressure and cholesterol, flagged only a small share of the people who already had plaque. In other words, many people with early disease would look low-risk on paper.
The team argues this points to a different model of prevention. Dr. Borja Ibáñez of CNIC described a shift from estimating the odds of disease based on risk factors to detecting the disease directly with imaging, before it causes symptoms. The idea is that catching plaque early could allow earlier, more tailored treatment.
What comes next
Besides the scans, the researchers gathered blood biomarkers, detailed molecular (“omics”) data and images of the retina, the light-sensitive layer at the back of the eye. The hope is to find cheaper or simpler signals that track with hidden plaque. The team also plans to expand the project to India, Singapore, Tanzania and Mexico, which would show whether the patterns hold in very different populations.
The catch
- It’s a snapshot. The study measured plaque at one point in time. It doesn’t show how many of these people will go on to have heart attacks or strokes, or how fast their plaque will grow.
- Plaque isn’t the same as a heart attack. Small amounts of early plaque are common, and finding it doesn’t mean an event is imminent.
- Screening isn’t proven yet. Whether scanning healthy people actually prevents heart attacks is the open question. The project’s next phase, planned for 2027 to 2032, will test that in randomized trials.
- European volunteers. Participants came from Denmark and Spain, so the exact numbers may differ in the United States.
- Funding. The first phase was funded by the Novo Nordisk Foundation.
What it means for you
For now, this study isn’t a reason to go looking for an artery scan on your own. It is a reminder that heart health isn’t only something to think about later. Heart disease causes about 1 in 5 deaths in the United States and is the country’s leading cause of death, according to the CDC.
The CDC names three main risk factors: high blood pressure, high cholesterol and smoking. About 47% of Americans have at least one of them. Diabetes, obesity, an unhealthy diet, too little physical activity and drinking too much alcohol also raise risk. Many of these can be checked with a routine visit and simple tests, and many respond to changes in habits or treatment.
If you’re in your 20s or 30s and haven’t had your blood pressure or cholesterol checked in a while, this is a good nudge to ask about it at your next checkup.
This article is for general information, not medical advice.
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