Atherosclerosis can begin developing at a young age, long before any symptoms appear. An international study known as REACT has found signs of the disease in more than half of apparently healthy adults.
The findings were presented at the 2026 Congress of the European Society of Cardiology (ESC) and published simultaneously in The New England Journal of Medicine.
Researchers examined 16,808 people aged 18 to 70 from Denmark and Spain who had no diagnosed cardiovascular disease. Using advanced imaging techniques, they looked for atherosclerotic plaques in the coronary, carotid and femoral arteries.
The results showed that 57.1% of participants had atherosclerotic plaques, even though most of them had no symptoms.
Atherosclerosis was detected even among the youngest participants. Among people aged 18 to 29, approximately one in 13 already had signs of the disease in at least one artery. In the 60–70 age group, the proportion rose to around 90%.
The researchers also identified significant differences between men and women. Signs of atherosclerosis began accumulating earlier in men, approximately five to 10 years earlier than in women. Among women, the sharpest increase in prevalence occurred between the ages of 40 and 60, a period that largely overlaps with the menopausal transition.
The authors note that existing cardiovascular risk assessment tools, which rely on factors such as age, blood pressure and cholesterol levels, may identify only a fraction of people who already have atherosclerosis but have not yet developed symptoms.
“This study shows that we can now take the next step and directly detect the disease before it causes a heart attack or stroke,” said the study’s scientific lead, Borja Ibáñez, scientific director of Spain’s Carlos III National Cardiovascular Research Center.
According to Ibáñez, atherosclerosis screening could eventually be performed using portable ultrasound devices. Such an approach could make it possible to detect the disease at an earlier stage and begin preventive measures sooner.
The researchers believe the findings could change the way cardiovascular disease prevention is approached. Instead of assessing only a person’s likelihood of developing cardiovascular disease, doctors may eventually be able to take into account whether atherosclerotic plaques are already present.
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