Insights
How Early Does Artery Plaque Begin?
A large study published in the New England Journal of Medicine in August 2026 imaged the arteries of 16,808 adults ages 18 to 70 in Denmark and Spain. None had known heart disease. Each person had ultrasound of the neck (carotid) and upper leg (femoral) arteries and a CT scan of the heart (coronary) arteries. We have put the study's main findings into the charts below.
Source: Bundgaard H, Garcia-Lunar I, et al. Prevalence of Silent Atherosclerosis across Adult Life. N Engl J Med 2026. The REACT study. Hover or tap any point for the exact value.
Plaque by age
Share of participants with plaque in at least one of the three artery areas. Overall, 57.1% had plaque: 63.4% of men and 50.9% of women.
The authors found that the pattern in men ran about 5 to 10 years ahead of the pattern in women. In women, the steepest rise came between 40 and 60, which the authors note overlaps with the menopausal transition.
Values for ages 18 to 39 and 60 to 70 are reported in the paper's text. Values for ages 40 to 59 are approximate, read from the paper's Figure 1A.
Where the plaque was found
Among younger adults, plaque was most often found in the neck arteries. Heart artery plaque was more common in the older age groups, and less common in women than in men at every age.
Approximate values read from the paper's Figures 1C and 1D.
One area, or several
In younger adults, plaque was most often found only outside the heart. With age, more people had plaque in the heart arteries and elsewhere at the same time. Among adults 60 to 70, all three areas had plaque in 56.3% of men and 30.7% of women. Plaque in the heart arteries alone was uncommon at every age, at most 9.3% of men and 5.0% of women.
Approximate values read from the paper's Figure 1B.
What a standard risk score caught
Doctors in Europe often use a 10-year risk score called SCORE2 to estimate heart risk. In this study, the score missed most people who already had plaque. Pick a risk group to see how many of every 100 people with plaque it would have flagged.
34 of every 100 people with plaque were placed in the moderate-to-high risk group (sensitivity 34.1%).
Very few people without plaque were placed in the high-risk group (specificity 99.8%), but that group also included very few of the people who had plaque. The authors note that these scores are strongly influenced by age and are not calibrated for adults under 40 in Europe.
What this study can and cannot tell us
- It is a snapshot. Each person was imaged once, so the age pattern compares different people of different ages. It does not track how plaque grows within one person.
- Participants came from Denmark and Spain. Results may differ in other populations.
- Healthier people may have been more likely to enroll, so the authors say the true numbers could be higher.
- The authors write that prevention guided by imaging may improve risk assessment and may be worth starting early in life.
Show all values as a table
| Measure | Group | 18-29 | 30-39 | 40-49 | 50-59 | 60-70 | Source in paper |
|---|---|---|---|---|---|---|---|
| Any plaque | Men | 8.7% | 34.6% | ~66% | ~88% | 98.1% | Results text; Fig. 1A |
| Any plaque | Women | 6.7% | 21.3% | ~47% | ~75% | 91.9% | Results text; Fig. 1A |
| Neck (carotid) | Men | ~5% | ~20% | ~41% | ~66% | ~82% | Fig. 1C/1D |
| Leg (femoral) | Men | ~3% | ~13% | ~32% | ~57% | ~80% | Fig. 1C/1D |
| Heart (coronary) | Men | ~2% | ~9% | ~31% | ~55% | ~79% | Fig. 1C/1D |
| Neck (carotid) | Women | ~5% | ~16% | ~36% | ~57% | ~78% | Fig. 1C/1D |
| Leg (femoral) | Women | ~2% | ~6% | ~17% | ~39% | ~62% | Fig. 1C/1D |
| Heart (coronary) | Women | ~1% | ~3% | ~10% | ~26% | ~48% | Fig. 1C/1D |
| Neck or leg only | Men | ~7% | ~26% | ~35% | ~33% | ~19% | Fig. 1B |
| Heart plus neck or leg | Men | ~1% | ~5% | ~22% | ~48% | ~75% | Fig. 1B |
| Heart only | Men | ~0.5% | ~4% | ~9% | ~7% | ~4% | Fig. 1B |
| Neck or leg only | Women | ~6% | ~19% | ~38% | ~49% | ~44% | Fig. 1B |
| Heart plus neck or leg | Women | ~0.5% | ~1% | ~6% | ~21% | ~44% | Fig. 1B |
| Heart only | Women | ~0.3% | ~1% | ~3% | ~4% | ~3% | Fig. 1B |
Bundgaard H, Garcia-Lunar I, Kofoed KF, et al., for the REACT Investigators. Prevalence of Silent Atherosclerosis across Adult Life. N Engl J Med. Published August 29, 2026. DOI: 10.1056/NEJMoa2609059. Percentages are among the 13,186 participants with complete imaging of all three areas. This page is for education and is not medical advice.