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A study of 16,808 adults ages 18 to 70 found imaging evidence of atherosclerotic plaque in 57.1% of participants who had no symptoms or prior cardiovascular disease diagnosis. About 1 in 13 participants ages 18 to 29 had plaque in at least one of three artery areas examined; the finding does not establish that they will develop symptomatic disease.
An international study of 16,808 adults without known cardiovascular disease found imaging signs of artery plaque in about 1 in 13 participants ages 18 to 29, offering a measure of how early silent atherosclerosis can be detected. The findings, from Denmark and Spain, were presented at ESC Congress 2026 and published in The New England Journal of Medicine.
The first phase of the REACT study enrolled adults ages 18 to 70 who had no symptoms or previous diagnosis of atherosclerotic cardiovascular disease. Researchers used advanced imaging to look for plaque in the carotid arteries in the neck, femoral arteries in the legs, and coronary arteries supplying the heart. Across all ages, plaques were detected in 57.1% of participants.
The prevalence varied substantially by age. About 1 in 13 people ages 18 to 29 had signs of atherosclerosis in at least one of the three areas examined. The share rose steadily in older groups; among participants ages 60 to 70, about 9 in 10 had plaque. These are findings from the study population, not estimates that every person in those age groups has the same likelihood of plaque.
The researchers also reported that most participants with coronary artery plaque had plaque in the carotid or femoral arteries. That overlap may matter for future screening research because those areas can be examined with ultrasound, while coronary imaging commonly involves CT. The study identified different age patterns in men and women: prevalence appeared to rise earlier in men, while women had their sharpest increase between ages 40 and 60. The supplied report does not give detailed subgroup percentages.
What Early Plaque Detection Could Change
The results draw attention to a gap between risk estimates and detectable disease. Current prevention commonly uses factors such as blood pressure, cholesterol and smoking to estimate a person’s future cardiovascular risk. REACT researchers are investigating whether imaging for plaque could add direct evidence about whether atherosclerosis is already present, potentially helping clinicians tailor prevention.
That possibility is not the same as a recommendation to screen all young adults. The study reports how often imaging found plaque; it does not show that population-wide scanning improves health outcomes, reduces heart attacks or strokes, or is cost-effective. Nor does a plaque finding mean a person will inevitably develop symptomatic cardiovascular disease. The value of the research for readers is its evidence that the process can begin before symptoms, alongside a clear reminder that prevalence alone cannot predict an individual’s future.
The reported overlap between coronary and neck or leg artery plaque offers a possible route for further investigation. If ultrasound in those more accessible arteries can reliably identify people who may benefit from closer assessment, it could inform a simpler screening approach. Whether that strategy works in routine care—and who should receive it—has not been established by these prevalence results.
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How the REACT Study Was Set Up
REACT is an international research project involving Rigshospitalet and other Danish hospitals, along with Spain’s Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC). Its first phase, called REACT-DETECT, began in 2024 and was designed to map silent atherosclerosis across adulthood and across three major vascular territories. Researchers also collected information on cardiovascular risk factors and blood biomarkers, samples for omics research, and retinal images.
The project is led by Professor Henning Bundgaard, a cardiologist at Rigshospitalet, and Dr. Borja Ibáñez, scientific director of CNIC and a cardiologist at Hospital Universitario Fundación Jiménez Díaz. The Novo Nordisk Foundation has awarded up to EUR 23 million to support the initiative’s first phase. The supplied report describes REACT as an effort planned across two phases and eight years, subject to funding for the second phase.
Atherosclerosis involves plaque building up inside arteries and is a major underlying cause of cardiovascular disease, which may later appear as a heart attack or stroke. It can develop for years without obvious symptoms. The REACT findings add imaging data on its presence, but do not by themselves establish when plaque began to form or how it will progress in any individual participant.
“The vision of REACT is to transform primary cardiovascular prevention through a precision medicine approach based on the early identification of atherosclerosis.”
— Professor Henning Bundgaard, REACT study lead
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What the Prevalence Results Cannot Show
The results describe plaque detected in the participants who were scanned; they do not establish how many will develop symptoms or experience a heart attack or stroke. The supplied report does not provide long-term outcome data, detailed prevalence figures for each artery or age subgroup beyond the headline age ranges, or information sufficient to assess how representative participants are of all adults in Denmark, Spain or other countries.
It also remains uncertain whether screening people without symptoms would lead to better health outcomes than current risk-based care. The study’s findings about plaque in accessible arteries do not prove that ultrasound can replace coronary CT or serve as a reliable screening test for everyone. The reported differences between men and women are patterns in the study, not proof that menopause causes the changes. Further results would be needed to assess those questions.
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The Planned Second REACT Phase
REACT’s first phase, REACT-DETECT, began in 2024 and produced the prevalence findings reported at ESC Congress 2026 and in The New England Journal of Medicine. The project outlines a second phase, REACT-PROTECT, planned for 2027 through 2032 if funding is granted. The supplied report does not detail its final protocol or confirm that the phase has been funded.
Future research will need to test whether imaging-based identification changes clinical decisions and improves outcomes, as well as determine which people should be scanned and how often. Researchers will also need to establish how well ultrasound of the carotid or femoral arteries identifies relevant disease, and whether its benefits justify the costs and potential downsides. Until those questions are answered, the current study is evidence about how common detected plaque was in its participants—not a new universal screening recommendation.
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Key Questions
What does “1 in 13 adults under 30” mean?
In this study, about 1 in 13 participants ages 18 to 29 had imaging signs of atherosclerosis in at least one of the carotid, femoral or coronary arteries examined. It is a result for the study group, not a diagnosis or individualized risk estimate for every young adult.
Does finding plaque mean a person will have a heart attack?
No. The report says having plaque does not mean a person will inevitably develop symptomatic cardiovascular disease. The study measured plaque prevalence; the supplied findings do not predict which participants will later have a heart attack or stroke.
How did researchers look for the plaque?
Researchers used advanced imaging to examine three artery areas: the carotid arteries in the neck, the femoral arteries in the legs and the coronary arteries supplying the heart. The report says most participants with coronary plaque also had plaque in the carotid or femoral arteries.
Should young adults get artery scans because of this study?
The reported findings do not establish that all young adults should be screened. Whether imaging people without symptoms improves outcomes, and which tests or groups would be appropriate, remains to be tested.
Source: rss
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