Silent atherosclerosis is detectable using imaging in early adulthood, with age-and sex-associated increases in prevalence across arterial territories and significant increases in plaque volume, based on results from the REACT trial presented at ESC Congress 2026 and simultaneously published in NEJM. The findings suggest the use of imaging from early adulthood “may provide an opportunity to improve primary prevention strategies and reduce the substantial burden of atherosclerotic cardiovascular disease,” researchers said.

REACT enrolled nearly 17,000 adults without known atherosclerotic cardiovascular disease (mean age 45; 51% women) from Denmark and Spain and placed them in five prespecified age strata that included a balanced number of men and women. Three-dimensional vascular ultrasonography of the carotid and femoral arteries, as well as coronary computed tomographic angiography (CCTA), were used to asses silent atherosclerosis at baseline.

Overall findings showed silent atherosclerosis was present in 57% of all the participants. Broken down by age, atherosclerosis was present in nearly 9% of men and 7% of women in the youngest age stratum (18 to 29 years), with prevalence increasing with age. Approximately 9 out of 10 individuals between the ages of 60 and 70 had atherosclerosis, researchers said.