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An international study of 16,808 adults in Denmark and Spain found signs of atherosclerosis in about 1 in 13 participants aged 18 to 29. Plaque was more common with age, but its presence alone does not mean a person will develop symptoms or have a heart attack or stroke.
An international study found signs of atherosclerotic plaque in about 1 in 13 adults aged 18 to 29 who had no symptoms or previous cardiovascular disease diagnosis, indicating that artery disease can be detectable in young adulthood. The findings come from 16,808 participants in Denmark and Spain and were presented at ESC Congress 2026 and published in The New England Journal of Medicine.
Researchers used advanced imaging to check three arterial areas: the carotid arteries in the neck, femoral arteries in the legs and coronary arteries supplying the heart. Across all participants, aged 18 to 70, plaque was detected in 57.1%. The study reports that the proportion rose with age: around 1 in 13 participants aged 18 to 29 had signs in at least one artery, compared with about 9 in 10 among those aged 60 to 70.
The study is the first phase of REACT, an international project examining silent atherosclerosis across adult life. The team also collected information on cardiovascular risk factors and blood biomarkers, along with samples and retinal images. The results describe how often imaging found plaque in this study group; they do not establish that each person with plaque will go on to develop symptomatic disease.
Researchers also reported that most participants with coronary artery plaque had plaque in either the carotid or femoral arteries. That overlap may be relevant to possible screening methods: ultrasound can image the neck and leg arteries without the CT scans used to examine coronary arteries. The study measured plaque prevalence, however, and does not by itself show that an ultrasound-based screening program improves health outcomes.
Plaque Appears Before Symptoms
The findings matter because atherosclerosis can develop without obvious symptoms for years, while cardiovascular disease may later appear as a heart attack or stroke. Detecting plaque in some participants in their 20s adds evidence that the process can begin well before conventional symptoms or a diagnosis. It does not mean that these young adults are destined to become ill: plaque is a sign of disease in an artery, not a prediction of an individual outcome.
The study raises a question for prevention: could direct imaging of arteries add useful information to assessments based on factors such as blood pressure, cholesterol and smoking? The researchers’ proposed approach is to identify disease itself and use that information alongside established risk factors. The current results establish prevalence, not whether imaging everyone at a young age would be beneficial, safe as a population policy or cost-effective.
The age and sex patterns may also inform future research. The team reported that plaque prevalence began rising at younger ages in men, with the overall pattern appearing about five to ten years ahead of that in women. Women’s sharpest increase was reported between ages 40 and 60, a period broadly overlapping with the menopausal transition. These are population patterns in the study, not a substitute for assessing a person’s individual risk.
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How the REACT Study Was Set Up
REACT is a two-phase project intended to study silent atherosclerosis and prevention. Its first phase, REACT-DETECT, began in 2024 and recruited 16,808 people aged 18 to 70 in Denmark and Spain who had no known history of atherosclerotic cardiovascular disease. The study was funded by the Novo Nordisk Foundation, which awarded up to 23 million euros to support the first phase.
Researchers led the work through a collaboration involving Rigshospitalet in Copenhagen and Spain’s Centro Nacional de Investigaciones Cardiovasculares, among other Danish hospitals. The results were released alongside their presentation at the 2026 European Society of Cardiology Congress. The project’s stated longer-term plan is to move from measuring where plaque is present to examining prevention strategies, subject to funding and further research.
The researchers frame this as a possible shift from estimating cardiovascular risk using established factors to detecting plaque directly through imaging. Those approaches are not necessarily alternatives: risk factors remain relevant, and the study does not establish that imaging should replace standard risk assessment. Its immediate contribution is a broad snapshot of plaque detected in three arterial territories across a large adult sample.
“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, professor of cardiology at Rigshospitalet and REACT study leader
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What the Scans Cannot Predict
The results show how often imaging identified plaque among the people enrolled; they do not report that all participants were followed long enough to determine who later developed heart attacks, strokes or other cardiovascular events. The study therefore cannot establish an individual’s future outcome from a plaque finding or show that early imaging prevents disease.
The source report does not give detailed participant-selection information beyond the countries, age range and lack of known cardiovascular disease, nor does it provide all age- and sex-specific figures in the supplied material. The reported 1-in-13 estimate applies to this study’s participants aged 18 to 29; it should not automatically be treated as the exact prevalence among all young adults. The comparison basis and precision of the age-group estimates are not specified here.
It also remains unclear whether ultrasound of the carotid and femoral arteries would work as a practical population screening tool, which people would benefit, and how clinicians should respond to a positive scan. The project’s proposed next phase is planned but depends on funding; no results from that phase are available in the report.
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A Planned Second Research Phase
REACT’s planned second phase, REACT-PROTECT, is intended to run from 2027 through 2032 if funding is granted. The source report describes it as the next stage of the project, but does not provide a confirmed start date, detailed trial design or specific clinical recommendations. Future research will need to test whether identifying plaque earlier changes treatment decisions and reduces cardiovascular events, rather than simply finding more cases.
For now, the published findings offer a prevalence snapshot and support further study of how plaque develops across adulthood and differs between men and women. They do not establish a new screening standard. Decisions about cardiovascular risk assessment or testing should continue to be made with qualified health professionals using an individual’s circumstances and established clinical guidance.
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Key Questions
What does “1 in 13 adults under 30” mean?
In this study, about 1 in 13 participants aged 18 to 29 had signs of atherosclerosis in at least one of the arteries examined. The figure describes the study group, not necessarily every young adult.
Does artery plaque mean a young person will have a heart attack?
No. The report says that having plaque does not mean a person will inevitably develop symptomatic cardiovascular disease. The study reports plaque prevalence and does not establish an individual’s future outcome.
Which arteries did researchers examine?
Researchers used imaging to look for plaque in the carotid arteries in the neck, femoral arteries in the legs and coronary arteries supplying the heart.
Does the study recommend ultrasound screening for everyone?
No population-wide screening recommendation is established by these results. A study leader proposed portable ultrasound as a possible future tool, but the report does not show that screening everyone improves health outcomes.
What happens in the next phase of REACT?
The project’s planned second phase, REACT-PROTECT, is expected to run from 2027 to 2032 if funding is granted. The supplied report does not provide a confirmed start date or detailed results from that planned phase.
Source: rss
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