It's a disease process that starts decades earlier.
We imagine heart disease as something that arrives suddenly after age 50 or when we get older.
Though the symptoms can appear as sudden chest pain, the disease itself has been silently accumulating.
Atherosclerosis, the disease process responsible for many heart attacks and strokes, doesn't happen overnight. Oftentimes it's asymptomatic for decades before problems arise.
My goal in today's article is to reframe the way you think about heart disease.
Not something far off in the distant future, but something that could be silently affecting you now.
What would your daily actions look like if you knew you had some stage of heart disease?
The bottom line: silent plaque was detected in 57.1% of them.
Importantly, none of the participants had known atherosclerotic cardiovascular disease. Recruitment was deliberately balanced across age groups and sex, rather than based on cholesterol levels or risk scores.
Historically, imaging cohort studies have focused on patients in middle and older age groups, when people typically become symptomatic.
The REACT study aimed to fill this age gap and observe when plaque first becomes detectable.
The researchers didn’t just look for plaque in the heart, but throughout the body.
Vascular ultrasound was performed on the carotid arteries in the neck and the femoral arteries in the groin. Participants also underwent coronary CT angiography.
This multiterritory approach allowed researchers to view atherosclerosis as a systemic disease rather than treating coronary plaque as the entire story.
Highlight findings from this study:
Silent atherosclerosis was found in 57.1% of nearly 17,000 adults who had no known cardiovascular disease.
Plaque was already present in young adults: among those aged 18–29, it appeared in 8.7% of men and 6.7% of women.
Older age groups had more widespread disease: in younger adults, plaque usually appeared in a single peripheral artery, while older groups had far greater plaque volume and more arteries involved.
Women lagged behind men, then caught up quickly: their prevalence ran roughly 5–10 years behind men’s, followed by a sharp rise between about 40 and 60
Disease isolated to the coronary arteries was uncommon: most people with coronary plaque also had plaque in the carotid or femoral arteries, suggesting simpler peripheral imaging could potentially aid early detection—though screening has not yet been proven to prevent events.
What this Study Doesn't Show
"Should I book an appointment with my cardiologist and get scanned as soon as possible?"
Even though the study found that most adults aged 60 to 70 had detectable disease, that doesn't mean every asymptomatic person needs to get scanned.
Detecting heart disease and demonstrating that a screening protocol improves mortality are two separate arguments.
What REACT does suggest: waiting for symptoms to surface is a poor prevention strategy.
It's never too early to take action and prevent heart disease. It's never too late to start either.
How?
Know and manage your blood pressure. Know and manage your apolipoprotein B and lipoprotein(a) levels. Do not smoke. Move regularly. Build a dietary pattern around minimally processed foods, fiber, plants, and healthy sources of protein and fat. Address diabetes, sleep, and excess visceral fat where relevant. Understand your genetics, family history, and other potential risk enhancers with a clinician.
Prevention Starts Now
The REACT study shows that vascular disease begins significantly earlier than most assume.
Autopsy studies have found fatty streaks, the earliest precursors of plaque, in the arteries of young children. The PDAY study found early lesions in the coronary arteries and aorta of many teenagers and young adults aged 15 to 34.
Atherosclerosis is a continuum.
It can begin early in life, remain localized for years, increase in volume, spread across the arterial system, and sometimes, decades later, produce a clinical event.
The heart attack may be sudden. The disease that caused it usually is not.
So perhaps the most useful question is no longer:
“Will I get heart disease someday?”
A better set of questions might be:
“What has my lifetime exposure been? Could the process already have started? What can I do now to slow or stabilize its trajectory?”
REACT’s great contribution is not simply the finding that 57% of its participants had plaque.
It is the recognition that primary prevention may not always be truly “primary.”
For many adults, prevention starts only after the disease’s first microscopic chapter has already been written.
Prevention starts now.
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* Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
