Silent Atherosclerosis: Insights from New Research

Recent research has uncovered that the buildup of artery-clogging plaque begins much earlier than many assume. The study found that approximately 1 in 13 adults, ages 18 to 29, exhibits signs of silent atherosclerosis—a condition characterized by the hardening of the arteries due to plaque accumulation—even in the absence of known cardiovascular disease. Furthermore, over half of all healthy adults studied showed plaque presence in their arteries, according to a comprehensive international study.

Researchers from Denmark and Spain utilized advanced imaging techniques to examine more than 16,800 adults aged 18 to 70, all without known cardiovascular disease. They identified plaque in 57.1% of participants, with prevalence increasing steadily with age—ranging from about 1 in 13 adults under 30 to around 9 in 10 adults aged 60 to 70. This research, published in The New England Journal of Medicine in August, highlights the early onset of atherosclerosis.

Atherosclerosis occurs when fatty deposits, cholesterol, and other substances accumulate inside arteries. This process often develops silently over many years before leading to a heart attack or stroke. Dr. Borja Ibáñez, a cardiologist and scientific director at Spain’s National Center for Cardiovascular Research (CNIC), stated, “This study shows that we can now go one step further and detect the disease directly before it causes a heart attack or stroke.”

The findings emerge from the initial phase of the ongoing international REACT study, intended to map the prevalence of silent artery plaque throughout adulthood. In the subsequent phase, researchers will evaluate whether early disease detection can enhance heart disease prevention. Professor Henning Bundgaard from Rigshospitalet in Copenhagen highlighted that atherosclerosis can be detected decades before clinical symptoms manifest, adding to our understanding of the disease’s evolution throughout life.

The study revealed gender differences in plaque development: Men generally develop plaque five to ten years earlier than women, while women experience a significant increase between ages 40 and 60. Researchers noted that current cardiovascular risk scores identified only a small proportion of people with silent atherosclerosis, indicating the potential for undetected cases under traditional assessments.

Portable ultrasound might eventually aid in earlier plaque detection, yet further clinical trials are necessary. Dr. Sirisha Vadali, a cardiologist at HonorHealth Women’s Heart Health in Arizona, emphasized, “Finding plaque doesn’t mean someone is about to have a heart attack, but finding it gives us an opportunity to address a patient’s risk factors.” Vadali advised against waiting for symptoms before focusing on heart health.

Healthy lifestyle choices, including abstaining from tobacco, maintaining physical activity, and consuming a balanced diet abundant in vegetables, fruits, beans, whole grains, nuts, and fish while limiting saturated fats and excess sodium, can safeguard heart health. Vadali cautioned that routine artery screening isn’t required for everyone under 30; decisions should be based on individual risk factors.