Hidden Artery Plaque Is More Common Than You Think. Here’s What to Ask For.
By Andres Zuleta, MD, ThriveMed · Patient education
Most people assume that if they feel fine and their numbers look "okay," their arteries are clean. A large study published this summer suggests that for many adults, that assumption is wrong.
Below, I walk you through what the study found, what it does not prove, and the three questions I would bring to your next visit.
Andres Zuleta, MD, ThriveMed physician, in a white coat and navy scrubs
The short version
Silent plaque is common. In the REACT study, 57.1% of adults with no known heart or artery disease already had plaque in their arteries.
It can start early. About 1 in 13 people aged 18 to 29 already had some.
Risk calculators missed most of it. A "high risk" score flagged only 1.9% of the people who had plaque.
It does not prove that scanning everyone helps. There is no heart attack or stroke data from this study yet, and routine imaging for young adults without symptoms is not in current guidelines.
Your next step is a conversation. Ask about your ApoB, your Lp(a) and whether a scan would change your plan.
What the study found
The study is called REACT. It was published on August 29, 2026 in the New England Journal of Medicine and presented at the European Society of Cardiology Congress. Researchers in Denmark and Spain scanned 16,808 adults aged 18 to 70 who had no known heart or artery disease. They looked in three places: the arteries in the neck, the legs and the heart. They did not estimate risk. They looked for the disease itself.
Here is what they saw:
57.1% had silent plaque, meaning plaque with no symptoms and no diagnosis.
About 1 in 13 people aged 18 to 29 already had some.
About 9 in 10 people aged 60 to 70 had it.
Men were 5 to 10 years ahead of women. Women showed a steep rise between 40 and 60, around the time of menopause.
Bar chart of silent artery plaque by age and sex in the REACT study, rising from 8.7% of men and 6.7% of women aged 18 to 29 to 98.1% of men and 91.9% of women aged 60 to 70
Silent artery plaque by age and sex. Data: REACT, NEJM 2026. The 40 to 59 age bands come from the NEJM supplement (Table S7); other figures were reported in the NEJM abstract, the ESC release or published coverage.
Two surprises worth knowing
1. Risk calculators missed most of it. Doctors often estimate your 10-year risk with a calculator. In Europe that tool is SCORE2. In REACT, a "high risk" SCORE2 result flagged only 1.9% of the people who actually had plaque. Calculators estimate odds. They don't look at your arteries.
2. A calcium score of zero isn't always the full story. A calcium score is a quick CT scan that finds hardened, calcified plaque in the heart arteries. In REACT, among people in their thirties who had plaque in their heart arteries, more than 4 in 10 had a calcium score of zero. Early plaque is often soft and hasn't calcified yet. A zero is still useful information. It just isn't a guarantee.
What this study does not prove
I want you to have the full picture, not just the headline.
It is a snapshot: one scan per person, at one point in time.
There is no heart attack or stroke data from this study yet.
It does not prove that finding and treating this plaque prevents heart attacks. The researchers plan a randomized trial to test exactly that.
Routine artery imaging for young people without symptoms is not in current guidelines.
The study enrolled similar numbers of people in each age band, so 57.1% is not a population-wide estimate.
All the participants were from Denmark and Spain, so we need to see the results in other populations.
The study was funded by the Novo Nordisk Foundation.
The three questions to bring to your next visit
1. "What is my ApoB?"
ApoB counts the cholesterol-carrying particles that can lodge in artery walls. The 2026 ACC/AHA cholesterol guideline notes that measuring ApoB can be useful. It is a simple blood test.
2. "Have I ever had my Lp(a) measured?"
Lp(a) is a largely inherited cholesterol particle. The 2026 ACC/AHA cholesterol guideline recommends measuring it at least once in every adult. If you've never had it checked, ask. I wrote more about Lp(a) here: Should You Get an Lp(a) Test? What a New Lancet Study Means for Your Care at ThriveMed.
3. "Would imaging change my plan?"
This is the key question. Depending on your age and history, your doctor might discuss:
Carotid or femoral ultrasound: no radiation, and it looks at the neck or leg arteries. In REACT, early plaque often showed up here first.
Coronary calcium score: a quick, low-dose CT that finds calcified plaque in the heart arteries.
Coronary CT angiography: a more detailed CT with contrast dye that can show soft and calcified plaque.
If the answer would change what you do, such as starting or intensifying treatment or adjusting targets, a scan may be worth discussing. If it wouldn't change anything, it may not be worth doing.
My take
What follows is my own view, not a result of the study: a normal-looking risk score should start the conversation about your arteries, not end it. That is what proactive clinical care means at ThriveMed. It is a new way of doing healthcare: we look for disease directly and early, and we are honest about what the evidence does and doesn't yet show.
You can find more of my writing and work at drzuleta.com.
Watch: the REACT study in 5 minutes
Want the quickest version? Watch the 52-second Short.
More from me: YouTube at Andres Zuleta, MD, Instagram at @andreszuletamd, and LinkedIn at Andres Zuleta, MD. You can also find me at drzuleta.com.
Frequently asked questions
What is the REACT study?
REACT is a large study published in the New England Journal of Medicine in August 2026. Researchers used ultrasound and CT to scan the neck, leg and heart arteries of 16,808 adults aged 18 to 70 in Denmark and Spain who had no known heart or artery disease.
Yes. In REACT, about 1 in 13 adults aged 18 to 29 without known heart disease had plaque in at least one of the arteries scanned.
Is plaque in my neck or legs related to my heart?
In REACT, most people with plaque in their heart arteries also had plaque in their neck or leg arteries. That is one reason ultrasound of these arteries is being studied as a screening tool.
If my calcium score is zero, am I in the clear?
A zero means no calcified plaque was seen, which is good news. But in REACT, many younger adults with heart artery plaque still had a zero, because early plaque is often soft.
Should I ask for a scan?
Ask whether a scan would change your plan. Routine imaging for young adults without symptoms isn't in current guidelines, and REACT hasn't yet shown that imaging-guided treatment prevents heart attacks.
Which blood tests matter most?
Ask about ApoB and make sure you've had Lp(a) measured at least once, alongside your standard cholesterol panel.
Book your visit
Want to talk through your own numbers? Schedule a visit with ThriveMed and bring the three questions above. We will look at your full risk picture together and decide whether a scan would change your plan.
Sources
Bundgaard H, et al. Prevalence of Silent Atherosclerosis across Adult Life (REACT). New England Journal of Medicine. Published online Aug 29, 2026. DOI: 10.1056/NEJMoa2609059.
European Society of Cardiology. Early imaging of atherosclerosis identifies silent disease not captured by conventional risk assessment. Press release, Aug 29, 2026.
American College of Cardiology. 2026 cholesterol guideline highlights.
American Heart Association. Atherosclerosis.
American Heart Association. Lipoprotein(a).
Educational content from ThriveMed, written by Andres Zuleta, MD. Not medical advice. Please discuss testing and treatment decisions with your own clinician.
Don't let a normal risk score end the conversation. Ask about the scan.