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.

In other findings, study investigators noted that atherosclerosis prevalence increased earlier in men, whereas women showed a later and particularly steep midlife increase, around the typical age for menopause. Plaque volume also increased exponentially with age, while isolated coronary-artery atherosclerosis was uncommon across all ages. Among younger participants, atherosclerosis was most often peripheral and confined to a single vascular territory.

“These data from multiple locations support the concept of silent atherosclerosis as a systemic, progressive disease process,” said Henning Bundgaard, MSc, PhD, from Rigshospitalet - Copenhagen University Hospital in Denmark. “Identifying and treating silent atherosclerosis as early as possible could help reduce the global burden of [cardiovascular disease]. Our findings support further prospective studies to investigate whether imaging-guided treatment of those with early evidence of disease – detected using a handheld ultrasound scanner – can improve current standards. If successful, this could support a precision medicine approach to atherosclerotic cardiovascular disease.”

Visit ACC’s ESC Congress 2026 coverage page to explore the latest science and key takeaways shaping cardiovascular care.

Keywords: ESC Congress, ESC26, Atherosclerosis, Cardiovascular Diseases, Prevalence