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Silent Artery Plaque Found in Young Adults
Confirmed
In Short: A new study found signs of artery-clogging plaque in some healthy young adults.
A new study published in The New England Journal of Medicine has found that artery-clogging plaque may begin forming much earlier than previously thought, even in young adults with no known cardiovascular disease.
The research, part of the ongoing international REACT study, examined more than 16,808 adults aged 18 to 70 with no known cardiovascular disease.
The study revealed that about one in 13 adults aged 18 to 29 already had silent atherosclerosis, the hardening of the arteries from plaque buildup.
Dr. Borja Ibáñez, a cardiologist and scientific director of Spain's National Center for Cardiovascular Research (CNIC), noted that until now, preventive decisions have been based on estimated risk, but the disease could already be present.
The study also found that men tended to develop plaque five to ten years earlier than women, while women experienced their steepest increase between ages 40 and 60.
Dr. Sirisha Vadali, a cardiologist at HonorHealth Women’s Heart Health in Arizona, emphasized that finding plaque does not mean someone is about to have a heart attack, but it gives an opportunity to address risk factors.
Researchers used advanced imaging techniques, including three-dimensional ultrasound, to examine the carotid and femoral arteries, where plaque often appears first.
The study suggests that portable ultrasound could eventually help identify hidden plaque earlier, but further clinical trials are needed.
"REACT shows that atherosclerosis can be detected decades before clinical manifestations appear and provides the most comprehensive atlas of the evolution of the disease across adult life," said Dr. Ibáñez.
"We shouldn't wait for symptoms to start paying attention to heart health," added Dr. Ibáñez.
The findings highlight the importance of early detection and prevention of cardiovascular disease, even before symptoms appear.
What's confirmed
- Researchers are studying whether earlier detection of artery plaque could improve heart disease prevention. (iStock) "Until now, preventive decisions have been based on an estimate of risk, but we did not know whether the disease was already present," Professor Henning Bundgaard, professor of cardiology at Rigshospitalet in Copenhagen, said.
- Most participants who had atherosclerosis in their coronary arteries also showed plaque in the carotid or femoral arteries.
What's still developing
- Gluck, vice chair of the Heart & Vascular Institute and system chief of cardiology at AtlantiCare in New Jersey, discusses a recent study that found stroke incidence has more than doubled among young adults.
- Knowing your blood pressure, cholesterol and other heart health risk factors can help reduce the risk of cardiovascular disease, experts say. (iStock) Researchers also found that commonly used cardiovascular risk scores only identified a small proportion of people who already had silent atherosclerosis, suggesting some cases may go undetected using traditional risk assessments alone.
- In the youngest group, plaque showed up in 8.7 percent of men and 6.7 percent of women.
- “In this model, preventive interventions and the treatment of risk factors could be guided by the actual presence of silent atherosclerosis rather than relying solely on an indirect estimate of risk,” Ibáñez said.
- Fatty plaque was already sitting inside the arteries of about 1 in 13 adults aged 18 to 29, none of whom had a diagnosis or a single symptom.
- Those numbers come from the REACT study, which scanned the arteries of 16,808 apparently healthy adults in Denmark and Spain.
- More than half of them, 57.1 percent, had atherosclerosis, the slow build-up of fat, cholesterol and calcium in artery walls that eventually causes most heart attacks and many strokes.
- The team recruited adults up to 70 with no known atherosclerotic disease and split them into five age bands of roughly equal size, with a balance of men and women in each.
- Among men, prevalence began increasing at younger ages.
- "In the paradigm we propose, portable ultrasound devices usable by any healthcare professional will become the standard tool for atherosclerosis screening from the early stages of adult life," Dr. Ibáñez said.
- A heart scan alone would have missed much of it, and isolated plaque in the coronary arteries turned out to be rare, at no more than 9.3 percent of men and 5.0 percent of women in any age band.
- Among people in their thirties who had coronary plaque on the angiogram, 41.8 percent of the men and 48.4 percent of the women had a calcium score of zero.