Observational study finds 57.1% of young adults have silent atherosclerosis — Evidence Review

A new multinational study found that hidden artery plaque is common even in adults under 30, with advanced imaging revealing silent atherosclerosis in 1 of every 13 people in this age group. Related research broadly supports these findings, showing that subclinical atherosclerosis frequently develops in youth and young adults and is often missed by traditional risk assessments, as summarized in the New England Journal of Medicine.

• Multiple autopsy and imaging studies confirm early onset of atherosclerosis, with fatty streaks and raised plaques present in adolescents and young adults, and significant proportions of asymptomatic young populations showing coronary or arterial lesions 1 2 3 5.
• The prevalence of subclinical atherosclerosis in healthy adults, including those with low traditional risk profiles, is consistently high across diverse cohorts and imaging modalities, aligning with the new study’s findings 4 6 10.
• Existing risk calculators frequently underestimate the presence of disease, prompting calls for direct detection through imaging as seen in the new study and echoed by others advocating for precision prevention strategies 4 6 9.

Study Overview and Key Findings

Atherosclerosis has long been understood as a disease of middle and older age, but its early development and detection in asymptomatic people are increasingly recognized as important for preventive medicine. The current study provides a large-scale, multinational assessment of silent atherosclerosis across adulthood, using advanced imaging to directly map the prevalence and distribution of hidden arterial plaque before clinical symptoms arise. This approach challenges conventional prevention strategies that rely primarily on risk estimation rather than direct evidence of disease.

Property	Value
Organization	Rigshospitalet, CNIC, Hospital Universitario Fundación Jiménez Díaz, CIBERCV
Journal Name	The New England Journal of Medicine
Authors	Professor Henning Bundgaard, Dr. Borja Ibáñez
Population	Adults ages 18 to 70 with no known cardiovascular disease
Sample Size	n=16808
Methods	Observational Study
Outcome	Prevalence of silent atherosclerosis
Results	Hidden plaque found in 57.1% of participants without known disease

Literature Review: Related Studies

To understand the broader context of this new research, we searched the Consensus paper database, which contains over 200 million research papers. The following search queries were used to identify related literature:

1. hidden artery plaque prevalence young adults
2. asymptomatic plaque detection methods
3. cardiovascular health risk factors under 30

Related Findings Grouped by Key Topics

Topic	Key Findings
How early does atherosclerosis begin, and how prevalent is it in youth and young adults?	- Atherosclerosis begins in adolescence, with fatty streaks and raised lesions commonly found in those aged 15–34; prevalence and extent increase rapidly with age 1 2 3. - Imaging studies show 11–22% prevalence of occult coronary artery disease in asymptomatic young adults, especially those with risk factors 2 5.
How effective are traditional risk factors and scores in identifying hidden atherosclerosis?	- Conventional risk calculators often miss subclinical atherosclerosis; many individuals with plaque have low predicted risk 4 6 10. - Imaging (coronary calcium, carotid/femoral ultrasound) improves risk prediction and reclassification over traditional risk factors alone 6 9.
What methods exist for detecting silent or subclinical arterial plaque?	- CT angiography, coronary calcium scoring, and vascular ultrasound are validated for detecting subclinical plaque; each method offers different strengths and limitations 7 8 9. - Carotid plaque and coronary calcium presence are strong predictors of future cardiovascular events independent of risk factors 8 9.
What are the implications for prevention and long-term cardiovascular risk?	- Early exposure to elevated blood pressure, cholesterol, and risk factors in young adulthood increases long-term CVD risk, independent of later exposures 11 12 13 14. - Lifestyle interventions in youth and young adults deliver greater cardiovascular benefit, supporting early preventive strategies 11 14 15.

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How early does atherosclerosis begin, and how prevalent is it in youth and young adults?

Multiple studies over several decades have demonstrated that atherosclerosis is not only a disease of older age but often begins in adolescence and young adulthood, sometimes progressing silently for decades. The new study’s finding of hidden plaque in 1 in 13 adults under 30 aligns closely with prior autopsy and imaging reports showing early arterial changes.

• Autopsy studies have revealed fatty streaks and raised lesions in the arteries of teenagers and young adults, with prevalence increasing rapidly from age 15 to 34 1 3.
• Intravascular imaging in young heart transplant donors and coronary CT angiography in asymptomatic young adults found substantial rates of early coronary atherosclerosis, particularly in those with moderate or high risk profiles 2 5.
• The prevalence of subclinical plaque in healthy cohorts (e.g., 11% in young Korean adults, 17% in teenage heart donors) is similar to the 1 in 13 rate in adults under 30 from the new study 2 5.
• The rapid rise in prevalence with age, and sex-specific patterns (earlier in men, accelerated after menopause in women), are consistent across studies and observed in diverse populations 1 3 4.

How effective are traditional risk factors and scores in identifying hidden atherosclerosis?

Traditional risk calculators—based on age, cholesterol, blood pressure, and smoking—frequently underestimate the actual burden of subclinical atherosclerosis. The new study demonstrates that a large proportion of adults with hidden plaque would not be identified as high risk using conventional scores.

• Several studies report that substantial numbers of individuals with significant plaque have low or intermediate predicted risk, highlighting the limitations of current risk stratification 4 6 10.
• Imaging-based detection (such as coronary calcium or ultrasound) identifies many cases that would otherwise be missed, and these findings are associated with higher rates of future cardiovascular events 6 9.
• The new study’s call for imaging-guided prevention echoes recommendations from other researchers for more personalized, precision-based approaches to cardiovascular risk management 4 6 9.
• Even in low-risk populations, significant subclinical disease is present, suggesting that traditional models may delay intervention until disease is well established 4 10.

What methods exist for detecting silent or subclinical arterial plaque?

A variety of imaging modalities have been validated for detecting subclinical atherosclerosis. The new study’s use of advanced imaging across three vascular regions is consistent with a growing body of research advocating for multi-territory assessments to capture the full burden of disease.

• Coronary CT angiography, coronary artery calcium scoring, and carotid/femoral ultrasound are effective for identifying asymptomatic plaque and are increasingly used in research and select clinical settings 7 8 9.
• Presence of carotid plaque or coronary calcium is independently associated with increased risk of future stroke and cardiac events, even after adjusting for traditional risk factors 8 9.
• While CT angiography provides detailed assessment of coronary arteries, ultrasound is non-invasive and suitable for broader screening, as suggested by the new study’s proposal for portable ultrasound screening 7 8.
• Cost, accessibility, and potential harms (such as overdiagnosis or radiation exposure) remain challenges for population-level screening, and further research is needed to assess the benefits and risks of widespread imaging 7 9.

What are the implications for prevention and long-term cardiovascular risk?

The evidence consistently shows that early vascular changes have lifelong consequences, and that early modification of risk factors can yield substantial reductions in cardiovascular disease burden. The new study adds urgency to calls for earlier detection and intervention.

• Studies have found that blood pressure and cholesterol exposures in young adulthood independently predict later cardiovascular events, regardless of risk factor levels in middle age 14.
• Combined healthy lifestyle factors (diet, exercise, non-smoking, healthy weight) deliver greater absolute benefits in youth and young adults than in older age, supporting the rationale for early intervention 11 14.
• Disparities in risk factor burden and outcomes among young adults, as well as unique behavioral and social challenges, have been highlighted as barriers to effective prevention 12 15.
• The new study’s findings bolster the argument for shifting prevention earlier in life, with potential to tailor screening and interventions by age, sex, and risk profile 11 12 13.

Future Research Questions

Despite advances in early detection, key questions remain regarding the optimal use of imaging, the long-term benefits of intervention, and how best to target prevention efforts in diverse populations. Further research is needed to clarify these issues and refine strategies for reducing the global burden of cardiovascular disease.

Research Question	Relevance
Does imaging-guided screening for silent atherosclerosis in young adults reduce future cardiovascular events?	Determining whether early detection and intervention based on imaging meaningfully lowers CVD incidence, as opposed to risk-factor-based prevention, is critical for public health policy 4 6 9.
What are the long-term risks associated with subclinical plaque detected in young adults?	Understanding which individuals with early, asymptomatic plaque are most likely to experience future events would help tailor interventions and avoid overtreatment 2 3 8 10.
How do sex and hormonal factors influence the development and progression of atherosclerosis in young adults?	Sex differences in onset and progression, and the role of hormonal transitions (e.g., menopause), remain incompletely understood and may inform more personalized prevention strategies 1 3 4 13.
What is the cost-effectiveness of population-based imaging screening for silent atherosclerosis?	Given health system constraints, assessing the balance of benefits, harms, and costs will be essential before implementing widespread imaging-based screening 7 8 9.
Can early lifestyle interventions reverse or halt the progression of subclinical atherosclerosis?	Evidence suggests that early lifestyle modification offers greater benefits, but whether it can reverse or stabilize early plaque in young adults is a key question for prevention 11 14 15.