Researchers have found that atherosclerosis may begin at an early age and continue to develop for many years without symptoms, meaning that the disease linked to heart attacks may be present decades before its complications appear.
The study, conducted by researchers from Denmark and Spain, included 16,808 adults aged between 18 and 70, none of whom had any known cardiovascular disease.
Comprehensive imaging tests, available to 13,186 participants, showed signs of atherosclerosis in more than 57% of them. The disease was even present among the youngest participants, with approximately one in 13 individuals aged 18 to 29 showing signs.
The prevalence of the disease increased with age. In their thirties, 34.6% of men and 21.3% of women had plaque in their arteries. Researchers also found that the disease begins in men about 5 to 10 years earlier than in women, while its rates increase more rapidly in women during middle age.
By age 60 to 70, only 1.9% of men and 8.1% of women showed no plaque. Plaque also became more prevalent in the arteries examined, appearing in the carotid arteries of the neck, the femoral arteries of the legs, and the coronary arteries of the heart in 56.3% of men and 30.7% of women in this age group.
Atherosclerosis occurs when fats, cholesterol, and other substances accumulate inside the walls of the arteries, forming plaques that can narrow the bloodstream or rupture and lead to the formation of a clot, which may cause a heart attack or stroke.
The study also revealed a gap between the actual presence of the disease and traditional risk estimates. When comparing imaging results with the SCORE2 tool, used to estimate the risk of cardiovascular disease over ten years, it was found that many individuals with atherosclerosis were not classified as high-risk.
Among participants aged 40 to 69, the SCORE2 tool identified only 1.9% of those with silent atherosclerosis as being at high risk.
However, the results do not mean that routine imaging tests should be carried out for everyone, as this phase of the study was limited to determining the extent of the disease and its progression, and did not test whether early detection leads to better health outcomes.
The researchers hope to conduct a large clinical trial in the next phase to test whether detecting atherosclerosis using imaging and early intervention can limit disease progression more effectively than current preventive methods.
The study results were published in the New England Journal of Medicine.
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