About 1 in 13 adults aged 18 to 29 in a Denmark and Spain imaging study already had plaque building in their arteries

Ultrasound of the neck and legs and CT scans of the heart’s own arteries turned up atherosclerosis in roughly 1 in 13 participants aged 18 to 29 in the REACT-DETECT study, people who had no symptoms and no diagnosis of cardiovascular disease. The same imaging protocol found plaque in 57.1 percent of all 16,808 participants aged 18 to 70, and in about 9 in 10 of those aged 60 to 70.

The REACT-DETECT cohort in Denmark and Spain

REACT is a prospective observational program led by Professor Henning Bundgaard of Rigshospitalet, Copenhagen University Hospital, and Dr. Borja Ibáñez, scientific director of Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC). Its first phase enrolled 16,808 adults aged 18 to 70 in Denmark and Spain, with a mean age of 45 and a balanced split of men and women across each decade of age, as the European Society of Cardiology presentation of the work describes it. The program is funded by a Novo Nordisk Foundation grant, and Phase 1 was designed to establish how common silent disease is at each point in adult life before any intervention is tested.

Anyone with a prior diagnosis of atherosclerotic cardiovascular disease was excluded, which is why the participants are described as apparently healthy even though the scans showed otherwise for more than half of them. Coverage of the study does not describe how volunteers were recruited, which is one more reason the rates describe this cohort rather than either country’s population. The European Society of Cardiology presentation, as relayed by News-Medical, adds that the design is a cross-section: each person was imaged once, so the study counts who has plaque on the day of the scan and does not follow anyone forward to see who goes on to a heart attack or stroke.

Plaque by age band, from 18-29 to 60-70

The youngest band is where the central figure sits. According to CNIC’s release of August 29, 2026, approximately 1 in 13 people aged 18 to 29 had atherosclerosis in at least one artery. That is about 7.7 percent, and it applies to that age band within this cohort of volunteers, not to every young adult in either country. At the other end, about 9 in 10 participants aged 60 to 70 had it. The overall 57.1 percent covers the whole 18-to-70 range, so it is an average across very different decades and not a rate for any single age group, least of all the young adults at the bottom of the range.

Sex shaped the timing of disease, and the split matters for who might be screened first. Men showed atherosclerosis five to ten years earlier than women, while women showed a later and particularly steep rise in midlife, around the typical age of menopause, with the sharpest increase between 40 and 60.

Three imaging methods for three arterial beds

Plaque was looked for in three places: the carotid arteries in the neck, the femoral arteries in the legs and the coronary arteries of the heart. Three-dimensional vascular ultrasound covered the carotid and femoral beds, and CT angiography with calcification assessment covered the coronaries. The CNIC release points out that ultrasound of the carotid and femoral arteries is easier, faster and non-invasive compared with CT scanning, a practical point for any screening program that might follow.

The study was published in the New England Journal of Medicine as “Prevalence of silent atherosclerosis across adult life” by Bundgaard, García-Lunar, Kofoed and colleagues, according to the citation HCPLive reproduced on August 29. A later summary of the results repeats the age-band split and names the same three leaders, with Dr. Valentín Fuster, CNIC’s director general, as the third.

SCORE2 and the screening gap

The sharpest practical finding concerns the standard risk calculator. SCORE2, the European tool that estimates ten-year cardiovascular risk from factors such as blood pressure and cholesterol, classified only a small minority of participants with silent atherosclerosis as high risk, with a marked lack of high-risk classification among the younger ones. Bundgaard, the study leader, said that because a person’s risk is currently estimated from risk factors, important opportunities to prevent cardiovascular events may be missed.

Ibáñez framed the aim as moving from the current model toward one in which the disease is detected directly through imaging before it causes symptoms. Whether finding plaque early changes outcomes is the part not yet answered. CNIC’s description of the next phase says REACT-PROTECT, running 2027 to 2032, will be a large randomized trial of imaging-guided prevention, funded alongside Phase 1 by the Novo Nordisk Foundation, which granted up to 23 million euros for the first phase. Fuster said of the question of whether early intervention can stop or reverse progression: “REACT will answer this question.”

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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