Nearly all men and more than nine in ten women in their 60s already have arterial plaques quietly building in their bodies, even without a single symptom. That is the central finding of the REACT study, presented at the European Society of Cardiology Congress on August 29, 2026 and published in the New England Journal of Medicine, which used advanced imaging to scan 16,808 adults aged 18 to 70 in Denmark and Spain. None had a known diagnosis of cardiovascular disease.
The condition is called subclinical atherosclerosis. Fatty deposits, cholesterol and other material build up inside artery walls over decades, forming plaques that narrow blood vessels without causing pain or fatigue. For many people, the first outward sign is a heart attack or a stroke. Cardiovascular disease, driven mainly by atherosclerosis, killed an estimated 19.8 million people worldwide in 2022, roughly a third of all global deaths.
Across the full sample, 57.1% of participants had detectable plaque. Prevalence climbed steadily with each decade of adult life. About 1 in 13 people aged 18 to 29 already had signs of atherosclerosis. In their 30s, 34.6% of men and 21.3% of women showed plaque. By ages 60 to 70, only 1.9% of men and 8.1% of women had none at all.
Men build plaque a decade before women
Men accumulate arterial damage earlier in life. "These data from multiple locations support the concept of silent atherosclerosis as a systemic, progressive disease process with men showing an approximately 5-to-10-year earlier atherosclerotic trajectory than women," Professor Henning Bundgaard of Rigshospitalet, the Copenhagen University Hospital that co-led the study, said in the European Society of Cardiology's press release.
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Women catch up sharply between the ages of 40 and 60, the period spanning menopause. The imaging in REACT looked directly for plaque in the neck, groin and heart arteries, using 3D vascular ultrasound and coronary CT angiography.
Standard risk tools miss almost everyone
Most primary-care clinics estimate a patient's cardiovascular risk with a calculator called SCORE2, which combines age, sex, blood pressure, cholesterol and smoking status to predict the odds of a heart attack or stroke over the next decade. In REACT, that calculator picked up only a small minority of people who already had silent atherosclerosis, with a particularly marked shortfall among younger participants. Bundgaard noted that such tools rely on estimation rather than direct knowledge that the disease is present.
Earlier imaging work has already flagged early signs of cardiovascular damage in a striking share of young adults, and REACT extends that picture across the full adult lifespan.
What the researchers want to change
The authors argue that imaging should move earlier in adult life, so plaques can be spotted and addressed before they cause a first event. "The future of cardiovascular prevention must be more precise and personalized. If we identify atherosclerosis in its earliest stages, we will be able to intervene sooner," said Professor Borja Ibáñez of the Centro Nacional de Investigaciones Cardiovasculares in Madrid, who co-led REACT.
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The researchers stop short of recommending routine artery scans for every adult, and REACT itself does not yet prove that catching plaque early saves lives. Anyone worried about heart-attack or stroke risk, particularly with a family history, high blood pressure or high cholesterol, should raise it with their doctor.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.