News · Longevity & Aging
Silent artery plaque turned up in 57% of 16,808 adults with no heart disease, and in some in their 20s
Plaque in the arteries builds for decades before it causes trouble. Scanning adults aged 18 to 70 in Denmark and Spain showed how early it starts and how fast it grows in midlife.
- A study that scanned the arteries of 16,808 adults aged 18 to 70 in Denmark and Spain, none with known heart disease.
- Plaque was found in 57% overall, including about 7% to 9% of people aged 18 to 29.
- Plaque grew sharply with age, and women's rise came later but steeper in midlife.
- Early plaque usually sat in the neck or leg arteries, not the heart.
- It maps how common plaque is; it does not show that scanning healthy people improves outcomes.
Heart attacks tend to feel sudden, but the disease behind most of them is anything but. Plaque builds in the artery walls over decades, silently, and a person can carry a great deal of it while feeling perfectly well. How early that process starts, and how common it is in people who have never had a symptom, has been surprisingly hard to pin down.
A study published in the New England Journal of Medicine scanned the arteries of 16,808 adults aged 18 to 70 in Denmark and Spain. More than half had plaque. So did a small but real share of people in their twenties.
What artery plaque is
MedlinePlus describes atherosclerosis as a condition in which plaque builds up inside your arteries, and explains that plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood. Over time, plaque hardens and causes your arteries to narrow.
The authors put the timeline plainly: atherosclerosis may begin in early adulthood and remain clinically silent for decades before cardiovascular disease manifests. Silent plaque is not harmless, either. It is associated with heart attacks and deaths even after accounting for the usual risk factors.
How the silent atherosclerosis study scanned 16,808 adults
The design was built to describe the whole of adult life evenly. Previously, how common silent plaque is at each age, and in women compared with men, had not been well defined. Adults 18 to 70 years of age without known atherosclerotic cardiovascular disease were enrolled in five prespecified age strata that included balanced numbers of women and men, so young adults and women were as well represented as older men.
Each person had two kinds of scan. Three-dimensional ultrasound looked at the arteries in the neck and groin, where plaque is easy to see from outside the body, and a CT scan with contrast dye looked at the arteries supplying the heart.
What the scans found at each age
Overall, silent atherosclerosis was present in 57.1% of the participants. In the youngest group, aged 18 to 29, it was present in 8.7% of the men and 6.7% of the women: fewer than one in ten, but far from zero at an age when heart disease is almost never considered.
The pattern changed with age in two ways. Prevalence rose steadily, with a later, steeper midlife rise among women. And the amount of plaque grew faster than the number of people with it: plaque volume increased exponentially and the prevalence of multiarterial involvement became more frequent as people got older.
Where the plaque sat was telling too. In younger adults it was usually in one place, most often the neck or leg arteries. Isolated coronary-artery atherosclerosis was uncommon in every age stratum, which means a heart scan alone would miss most early disease.
Why early artery plaque matters
The finding recasts heart disease as a condition of the whole adult lifespan rather than of later life. Plaque that is already visible in some people in their twenties has decades to grow, and the risk factors that feed it, such as high cholesterol, high blood pressure and smoking, are ones people can act on long before any symptom.
It also shows why checking only the heart’s arteries can mislead. Most early plaque in this study lay outside the heart, so scanning the neck and legs picked up disease that a coronary scan would not.
What an artery-plaque snapshot cannot tell us
This is a snapshot of plaque at one point in time, not a record of what happened to people afterward. It shows how common plaque is; it does not show how many of these people will go on to have a heart attack, or whether finding plaque early and treating it improves outcomes.
Participants were volunteers from Denmark and Spain, and people who sign up for a scanning study may be healthier or more health-conscious than average. Finding plaque in a healthy person can also lead to anxiety and further testing, which is one reason routine scanning of healthy people is not recommended without trial evidence that it helps.
What this changes for thinking about heart health
For most people, the practical message is the familiar one, with added urgency: the habits and numbers that drive plaque, blood pressure, cholesterol, smoking, activity and weight, matter from early adulthood, not just after 50.
For medicine, the study sets up the question that comes next. If plaque can be seen decades before symptoms, it may become possible to target prevention to the people who actually have it. Whether that works better than today’s approach has to be tested before scans of healthy arteries become routine.
People also ask
What did the study find?
Silent atherosclerosis was present in 57.1% of participants. In the youngest age stratum (18 to 29 years), it was present in 8.7% of men and 6.7% of women; prevalence increased with age, with a later, steeper midlife rise among women. Plaque volume increased exponentially with age, and isolated coronary-artery atherosclerosis was uncommon at every age.
What is silent atherosclerosis?
Plaque, a fatty, sometimes calcified buildup, in the walls of the arteries in someone who has no symptoms and no diagnosed heart or artery disease.
How was it measured?
With three-dimensional ultrasound of the neck (carotid) and groin (femoral) arteries, and a CT scan of the heart's arteries using contrast dye.
Does having plaque mean I will have a heart attack?
No. Plaque raises risk, and more plaque raises it more, but many people with small amounts never have an event. It is a risk marker, not a diagnosis of disease.
Should healthy people get their arteries scanned?
This study was not designed to answer that. Whether finding plaque in healthy people leads to better outcomes, rather than just more tests, has to be shown in other trials. This is general information rather than medical advice.
Why did women's plaque rise later?
The study describes the pattern without explaining it. The timing, a steeper rise in midlife, is consistent with changes around menopause, but that was not tested here.