The long interval before symptoms

# The long interval before symptoms OCTOBER 11, 2026 Artery plaque was found in 57.1% of adults who had no known heart disease, and it was present in the youngest group studied, aged 18 to 29, according to a large study in The New England Journal of Medicine. Prevention works with a difficult interval: changes may be underway while a person feels well. Mapping silent arterial plaque helps describe that interval, while leaving the essential question of useful intervention open. The work is a prospective cohort study, which means researchers enrolled people and measured them at the start. It is observational, not a trial. It enrolled 16,808 adults aged 18 to 70 in Denmark and Spain. None had known atherosclerotic cardiovascular disease. The average age was 45, and 51.4% were women. The study is called REACT, and the Novo Nordisk Foundation funded it. Atherosclerosis is the buildup of plaque inside artery walls. It can stay silent for decades before it shows up as heart disease. The authors note that silent plaque is linked to heart events and death even after accounting for traditional risk factors. What was less clear was how common it is at each age, in each sex, and in which arteries. To find out, the team scanned three areas. They used three-dimensional ultrasound on the carotid arteries in the neck and the femoral arteries in the legs. They used coronary CT angiography, a heart scan, on the coronary arteries. Participants were enrolled in five set age groups, with balanced numbers of women and men. Overall, 57.1% had silent atherosclerosis (95% confidence interval, 56.3 to 58.0). Among those aged 18 to 29, plaque was present in 8.7% of men and 6.7% of women. ScienceDaily, which covered the study, put this at about 1 in 13 young adults. Prevalence rose with age. Women showed a later, steeper rise in midlife. ScienceDaily reported that about 9 in 10 people aged 60 to 70 had plaque. That figure is not in the study's abstract, which is the only part of the paper we had. The same coverage said men's pattern ran five to ten years ahead of women's, and linked women's sharp rise at ages 40 to 60 to the menopausal transition. Those details also go beyond the abstract. The abstract does not explain the cause of the midlife rise in women. The pattern of disease changed with age. In younger groups, plaque was most often in the peripheral arteries, meaning the neck or legs, and confined to one area. With age, plaque volume grew exponentially, and plaque in several areas became more common. Plaque limited to the coronary arteries alone was uncommon at every age: no more than 9.3% of men and 5.0% of women. The study does not say that every person with plaque will have a heart attack or stroke. ScienceDaily notes that having plaque does not mean disease is inevitable. This study took one snapshot at enrollment. It did not test whether finding plaque and acting on it improves health. ScienceDaily also reported that standard risk scores, including SCORE2, identified only a small share of people with silent plaque. It also said most people with coronary plaque had plaque in the neck or leg arteries too. The abstract does not give these results, so they should be treated as the press account for now. The personal point is modest. The study shows artery changes can be detected in early adulthood, in the 18 to 29 group, years before symptoms would be expected. Our own view, which the study does not test, is that this is a reason to take blood pressure, cholesterol, smoking and activity seriously before middle age. Readers should discuss screening or any change in risk-factor management with their clinician rather than act on their own. The study also raises the question of whether direct imaging could add something to risk scores. It does not answer that. Dr. Borja Ibáñez, a lead researcher, told ScienceDaily the aim is a model in which "the disease is detected directly through imaging before it causes symptoms." That is a proposal, not a result. According to ScienceDaily, a second phase, REACT-PROTECT, is planned for 2027 through 2032 if funding is granted. Watch for whether it shows that acting on early plaque improves outcomes. Finding more disease is only the beginning of the argument. The result worth pursuing is a better outcome for the person whose disease was found. Sources: The New England journal of medicine (2026), ScienceDaily (reporting on The New England Journal of Medicine) The New England journal of medicine (2026),: https://doi.org/10.1056/nejmoa2609059 ScienceDaily (reporting on The New England Journal of: https://www.sciencedaily.com/releases/2026/09/260929053541.htm ---