Silent atherosclerosis is detectable using imaging in early adulthood, according to findings from the REACT trial presented at ESC Congress 2026 and simultaneously published in the New England Journal of Medicine. Researchers reported age- and sex-associated increases in prevalence across arterial territories alongside significant increases in plaque volume, suggesting that early imaging could reshape primary prevention strategies.
REACT Trial Data Reveals 57 Percent Overall Prevalence
The REACT trial enrolled nearly 17,000 adults without known atherosclerotic cardiovascular disease, according to the published data. Participants had a mean age of 45, and 51% were women. Researchers from Denmark and Spain placed participants into five prespecified age strata that included a balanced number of men and women. Investigators used three-dimensional vascular ultrasonography of the carotid and femoral arteries, as well as coronary computed tomographic angiography, to assess silent atherosclerosis at baseline.
Overall, silent atherosclerosis was present in 57% of all trial participants, according to the findings. When broken down by age, the condition appeared in nearly 9% of men and 7% of women in the youngest stratum, spanning ages 18 to 29. Prevalence climbed steadily across older groups, with approximately 9 out of 10 individuals between the ages of 60 and 70 showing evidence of atherosclerosis.
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According to REACT trial data, isolated coronary-artery atherosclerosis was uncommon across all ages. Among younger participants, atherosclerosis was most often peripheral and confined to a single vascular territory.
Sex Differences in Disease Progression and Midlife Increases
Atherosclerosis prevalence increased earlier in men, while women showed a later and particularly steep midlife increase, according to the study investigators. This sharp rise in women occurred around the typical age for menopause. Furthermore, plaque volume increased exponentially with age across the cohort.
“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. Bundgaard added that identifying and treating the condition as early as possible could help reduce the global burden of cardiovascular disease.
Precision Medicine and Handheld Ultrasound Potential
Investigators pointed out that deploying scans during early adult years could offer a chance to enhance preventive care models and lessen the heavy toll of atherosclerotic cardiovascular disease. According to Bundgaard, the results back the need for additional prospective investigations to determine whether managing patients with initial signs of the condition—identified via a portable ultrasound device—can elevate current benchmarks. If successful, this approach could support precision medicine for atherosclerotic cardiovascular disease.
Pro Tip
Explore ACC’s ESC Congress 2026 coverage page to examine the latest science and key takeaways shaping modern cardiovascular care.
Frequently Asked Questions
What was the REACT trial?
The REACT trial enrolled nearly 17,000 adults without known atherosclerotic cardiovascular disease from Denmark and Spain to evaluate silent atherosclerosis using vascular ultrasonography and coronary computed tomographic angiography.
At what age does silent atherosclerosis begin appearing?
According to the trial data, silent atherosclerosis was present in nearly 9% of men and 7% of women in the youngest age stratum, which covered ages 18 to 29.
How common is silent atherosclerosis in older adults?
Approximately 9 out of 10 individuals between the ages of 60 and 70 had atherosclerosis, according to findings presented at ESC Congress 2026.
What did researchers conclude about sex differences in the data?
Prevalence increased earlier in men, while women demonstrated a later and particularly steep midlife increase around the typical age for menopause.
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