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Rachel V Thomas

This Common Heart Attack Risk Starts Silently In Healthy People In Their 20s

<span>Atherosclerosis</span>, in which plaque builds up inside the arteries, is a major cause of <span>cardiovascular disease</span> and can lead to heart attacks, strokes and sudden death. A new study published in The New England Journal of Medicine found that plaque buildup can begin decades before symptoms appear.

An international team of researchers found atherosclerosis in many apparently healthy young adults, including those in their 20s.

Dr Borja Ibáñez, Scientific Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), said the findings point to a new approach to cardiovascular prevention: detecting atherosclerosis through imaging before symptoms appear, rather than relying only on risk factors such as blood pressure, cholesterol and smoking.

The study included 16,808 people aged 18 to 70 from Denmark and Spain. None had a known history of atherosclerotic cardiovascular disease.

Using advanced imaging, researchers examined the carotid, femoral and coronary arteries for plaque. Overall, 57.1% of participants had atherosclerotic plaques, despite having no symptoms or previous diagnosis of cardiovascular disease. 

Atherosclerosis was detectable even among the youngest participants. Among those aged 18 to 29, plaque was found in:

<ul><li>8.7% of men</li><li>6.7% of women</li></ul>

The prevalence increased with age, reaching nearly 90% among people aged 60 to 70. By 60–70, only about 1.9% of men and 8.1% of women had no detectable plaque in any of the arteries examined.

The study found differences between men and women. Atherosclerosis began increasing at younger ages in men, with their atherosclerotic profile appearing five to 10 years earlier than in women.

In women, the sharpest increase occurred between 40 and 60, broadly coinciding with the menopausal transition.

<h2>Could Ultrasound Detect Silent Atherosclerosis?</h2>

Conventional <span>cardiovascular risk</span> scores, including SCORE2, identified only a small proportion of people who already had silent atherosclerosis.

Researchers found that people with coronary artery plaque often also had plaque in the carotid or femoral arteries. Because these arteries can be examined using relatively simple, non-invasive ultrasound, the finding could have implications for future screening.

Dr. Ibáñez said portable ultrasound devices could potentially become a tool for detecting atherosclerosis from early adulthood.

“The future of cardiovascular prevention must be more precise and personalized,” he said, adding that early detection could allow earlier intervention and more targeted treatment.

<h2>Plaque Does Not Mean A Heart Attack Is Imminent</h2>

Dr. Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, said atherosclerosis can remain silent for decades before causing a heart attack, ischemic stroke or peripheral arterial disease.

However, having plaque does not mean a heart attack or stroke is imminent. Greater plaque burden and more widespread disease are associated with higher cardiovascular risk.

He also stressed that atherosclerosis is not simply an unavoidable consequence of ageing. Its progression can be slowed by addressing modifiable risk factors.

<h2>How To Lower Cardiovascular Risk</h2>

<ul><li>Regular aerobic and strength exercise</li><li>Avoiding tobacco</li><li>Eating a <span rel="noindex">healthy diet</span> and limiting ultra-processed foods</li><li>Controlling blood pressure</li><li>Managing LDL cholesterol/ApoB when indicated</li><li>Preventing and treating diabetes</li><li>Maintaining a healthy waist</li><li>Getting adequate sleep.</li></ul>

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Atherosclerosis, in which plaque builds up inside the arteries, is a major cause of cardiovascular disease and can lead to heart attacks, strokes and sudden death. A new study published in The New England Journal of Medicine found that plaque buildup can begin decades before symptoms appear.An international team of researchers found atherosclerosis in many apparently healthy young adults, including those in their 20s.Dr Borja Ibáñez, Scientific Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), said the findings point to a new approach to cardiovascular prevention: detecting atherosclerosis through imaging before symptoms appear, rather than relying only on risk factors such as blood pressure, cholesterol and smoking.Plaque Can Appear In The 20sThe study included 16,808 people aged 18 to 70 from Denmark and Spain. None had a known history of atherosclerotic cardiovascular disease.Using advanced imaging, researchers examined the carotid, femoral and coronary arteries for plaque. Overall, 57.1% of participants had atherosclerotic plaques, despite having no symptoms or previous diagnosis of cardiovascular disease. Atherosclerosis was detectable even among the youngest participants. Among those aged 18 to 29, plaque was found in:8.7% of men6.7% of womenThe prevalence increased with age, reaching nearly 90% among people aged 60 to 70. By 60–70, only about 1.9% of men and 8.1% of women had no detectable plaque in any of the arteries examined.Men Develop Plaque EarlierThe study found differences between men and women. Atherosclerosis began increasing at younger ages in men, with their atherosclerotic profile appearing five to 10 years earlier than in women.In women, the sharpest increase occurred between 40 and 60, broadly coinciding with the menopausal transition.Could Ultrasound Detect Silent Atherosclerosis?Conventional cardiovascular risk scores, including SCORE2, identified only a small proportion of people who already had silent atherosclerosis.Researchers found that people with coronary artery plaque often also had plaque in the carotid or femoral arteries. Because these arteries can be examined using relatively simple, non-invasive ultrasound, the finding could have implications for future screening.Dr. Ibáñez said portable ultrasound devices could potentially become a tool for detecting atherosclerosis from early adulthood.“The future of cardiovascular prevention must be more precise and personalized,” he said, adding that early detection could allow earlier intervention and more targeted treatment.Plaque Does Not Mean A Heart Attack Is ImminentDr. Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, said atherosclerosis can remain silent for decades before causing a heart attack, ischemic stroke or peripheral arterial disease.However, having plaque does not mean a heart attack or stroke is imminent. Greater plaque burden and more widespread disease are associated with higher cardiovascular risk.He also stressed that atherosclerosis is not simply an unavoidable consequence of ageing. Its progression can be slowed by addressing modifiable risk factors.How To Lower Cardiovascular RiskRegular aerobic and strength exerciseAvoiding tobaccoEating a healthy diet and limiting ultra-processed foodsControlling blood pressureManaging LDL cholesterol/ApoB when indicatedPreventing and treating diabetesMaintaining a healthy waistGetting adequate sleep.

this common heart attack risk starts silently in healthy people in their 20s

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