Subclinical Atherosclerosis in Young People: Your Arteries Are Keeping Score Before You Feel Anything

Plaque does not wait for symptoms. In the REACT study of 16,808 adults ages 18 to 70 in Denmark and Spain with no known heart disease, silent plaque was already common in young adulthood and almost universal by older age.

Here is the finding to highlight:

Subclinical atherosclerosis, meaning plaque present before symptoms, was already found in 6.7% of women and 8.7% of men ages 18 to 29, and in 21.3% of women and 34.6% of men ages 30 to 39. Plaque volume rose sharply with age, so more than 90% of participants ages 60 to 70 had some plaque. Men had more plaque earlier, women largely caught up at older ages, with a marked rise around menopause. Carotid and femoral plaque often appeared before coronary plaque, which could matter for earlier screening.

Why it matters

Risk factors were already common in young adults. Among men ages 18 to 29, about 22% had hypertension, meaning high blood pressure, and about 22% had dyslipidemia, meaning abnormal cholesterol or related lipids, including 5% with low-density lipoprotein cholesterol, often called LDL or bad cholesterol, at 160 mg per deciliter or higher.

The authors say risk scores alone missed many people with plaque,

That last point is key. If we rely only on a calculator, we miss people who already have disease. And if we rely only on symptoms, we will be even later, because symptoms are a late signal.

The good news is the runway is long. Carotid and femoral plaque can be found with ultrasound, which is portable, less costly than CT, and avoids radiation and contrast dye. More importantly, the basics still matter most: heart-healthy eating, regular movement, healthier weight, not smoking, and knowing your blood pressure, cholesterol, and blood sugar.

Small choices in your 20s and 30s compound for decades. 

General information only, not medical advice for any one person. Talk with your clinician about your own risk.

Sources

Prevalence of Silent Atherosclerosis across Adult Life, Bundgaard and colleagues, New England Journal of Medicine 2026;395:1818-1829
https://doi.org/10.1056/NEJMoa2609059

Atherosclerosis across the Adult Lifespan, A Call to Act from REACT, Post and Khera, New England Journal of Medicine 2026;395:1861-1863
https://doi.org/10.1056/NEJMe2612403