Artery plaque showed up in 1 of every 13 adults aged 18 to 29

Henning Bundgaard, the Rigshospitalet cardiologist who leads the Danish side of the REACT study, says conventional prevention “relies on an estimation – not on knowledge of the presence of the actual disease,” a gap his team set out to close. The group imaged 16,808 adults who had no known cardiovascular disease and found atherosclerosis already present in about 1 of every 13 participants aged 18 to 29.

That rate applies to the youngest band only. Across all ages from 18 to 70, 57.1% of participants had plaque somewhere in the arteries they were scanned for.

Three arterial territories, two countries

The study, called REACT-DETECT in its first phase, enrolled adults aged 18 to 70 in Denmark and Spain, none with a history of atherosclerotic disease. Participants received ultrasound of the carotid arteries in the neck and the femoral arteries in the legs, plus CT angiography of the coronary arteries, according to the release from Spain’s CNIC, which co-led the work. ScienceAlert’s coverage reports that 13,186 participants completed imaging of all three territories.

The results appeared in the New England Journal of Medicine, and the European Society of Cardiology distributed a press release on August 29, 2026. The ESC summary gives a mean participant age of 45. ScienceDaily’s version, published a month later, states the youngest-band finding as “about 1 in 13 participants ages 18 to 29 had signs of the disease in at least one artery.”

The study ran through Rigshospitalet in Copenhagen, Spain’s Centro Nacional de Investigaciones Cardiovasculares Carlos III and Madrid’s Hospital Universitario Fundación Jiménez Díaz. CNIC’s director general, Valentin Fuster, is among the named investigators, and Bundgaard has described the vision as transforming primary cardiovascular prevention “through a precision medicine approach.”

One in 13 works out to roughly 7.7%, and the arithmetic of the other bands shows why the age label matters. A reader who saw only the cohort-wide 57.1% would picture a population of the middle-aged and older, since the mean participant age was 45; a reader who saw only the 18-to-29 figure would underestimate how common plaque becomes by the 30s and 40s. The two numbers describe different slices of the same 16,808 people.

The wording “at least one artery” carries the weight. A positive result means plaque in any of the three imaged territories, not coronary disease necessarily, and not symptoms. CNIC’s summary is explicit that having arterial plaque does not guarantee a person will go on to develop symptomatic disease, and the youngest band’s 1-in-13 rate describes imaging findings in people who felt well, not diagnoses or events such as heart attacks.

Prevalence by decade and by sex

The curve steepens quickly. Among participants in their 30s, ScienceAlert reports plaque in 34.6% of men and 21.3% of women. By ages 60 to 70, about 9 in 10 participants had atherosclerosis, and only 1.9% of men and 8.1% of women in that band were plaque-free. CNIC says men showed disease five to ten years earlier than women, while women’s prevalence rose most sharply between ages 40 and 60, the years around menopause.

Plaque burden also spread across territories as the decades passed, not just in prevalence. In the 60-to-70 group, 56.3% of men and 30.7% of women had plaque in all three territories at once.

The gap in conventional risk scores

Bundgaard’s point about estimates is a criticism of tools such as SCORE2, the European risk calculator that combines age, blood pressure, cholesterol and smoking. News-Medical’s report quotes the study team’s conclusion that conventional assessment “identifies only a small proportion of people who already have silent atherosclerosis.” ScienceAlert puts a figure on it for the 40-to-69 group: SCORE2 classified only 1.9% of participants with detectable atherosclerosis as high-risk.

The ESC release quotes Bundgaard on the stakes: “Identifying and treating silent atherosclerosis as early as possible could help reduce the global burden of CVD.” The sentence is an argument for earlier action, and it is not a result of the study; the trial that would test it has yet to run.

Borja Ibáñez, CNIC’s scientific director, argues for a different model. He said portable ultrasound devices could “become the standard tool for atherosclerosis screening,” moving prevention from risk estimation to direct detection of disease.

The Novo Nordisk Foundation provided €23 million for the first phase, which began in 2024, and the ESC summary says a randomized trial of imaging-guided treatment is planned as the REACT Initiative’s second phase. What the 1-in-13 figure cannot show is whether treating plaque in a 25-year-old changes anything later; that is the question the second phase, a randomized trial of imaging-guided treatment, is meant to test, with the Novo Nordisk Foundation’s backing already behind the opening imaging phase.

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

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