New research indicates that using imaging to detect silent atherosclerosis from early adulthood may provide an opportunity to improve primary prevention strategies and reduce the global burden of atherosclerotic cardiovascular disease (CVD).
The REACT study, funded by Novo Nordisk Foundation and presented at the 2026 European Society of Cardiology (ESC) congress, taking place 28-31 August in Munich, Germany, used imaging to measure silent atherosclerosis in 16,808 adults without known CVD aged 18 to 70 years old in a cross-sectional study.
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Researchers involved in REACT used three-dimensional vascular ultrasound to assess atherosclerosis in the carotid and femoral arteries, and CT angiography for the coronary arteries.
Silent atherosclerosis, referring to the gradual, asymptomatic buildup of fatty plaque in the arteries that can lead to stroke and heart attack, was present in 57.1% of participants. The research found that the condition was already present in approximately 1 in 13 participants aged 18–29 years and 9 out of 10 participants aged 60–70 years, with prevalence increasing with age in an S-shaped curve.
Atherosclerosis prevalence increased earlier in men, with women displaying a later and especially pronounced mid-life increases. Meanwhile, rising age was associated with expansion of atherosclerosis and an exponential increase in age-related atherosclerotic plaque volume.
Following presentation of the REACT study’s results at ESC 2026, the data has been published in the New England Journal of Medicine.
Professor Henning Bundgaard from Denmark’s Rigshospitalet – Copenhagen University Hospital,, who co-led the REACT study, commented: “These data from multiple locations support the concept of silent atherosclerosis as a systemic, progressive disease process with men showing an approximately 5-to-10-year earlier atherosclerotic trajectory than women.”
The researchers also examined the extent to which conventional cardiovascular risk assessment classifies participants with silent atherosclerosis as high risk. They found that the SCORE2 risk tool classified only a small minority of participants with silent atherosclerosis in this group, with a marked lack among younger participants.
Bundgaard continued: “Identifying and treating silent atherosclerosis as early as possible could help reduce the global burden of CVD. 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.”
Based on the presented findings, a major randomised trial is planned as part of the second phase of the REACT initiative.
CVDs are the leading cause of death globally. An estimated 19.8 million people died from CVDs in 2022, representing approximately 32% of all global deaths, as per the World Health Organization (WHO).
