The researchers looked for plaque with three-dimensional ultrasound of the carotid arteries in the neck and femoral arteries in the legs. They also used coronary CT angiography to examine heart arteries. Participants were divided into five age groups, with balanced numbers of women and men in each group.
Silent atherosclerosis was present in 57.1% of participants overall. That does not mean more than half of all adults have undiagnosed plaque: The result describes this two-country cohort, whose mean age was 45, and prevalence varied dramatically by age.
The pattern changed with age
In younger participants, plaque was usually found outside the heart and confined to a single vascular territory. With increasing age, plaque volume rose sharply and involvement of multiple arterial regions became more common. Isolated plaque in a coronary artery was uncommon in every age group.
Men showed an earlier increase in prevalence. Women had a later, steeper rise around midlife. By ages 60 to 70, silent atherosclerosis was found in about 9 in 10 participants, according to the European Society of Cardiology’s summary of the research.
Atherosclerosis is a buildup of material in artery walls. It can progress without symptoms for years before contributing to heart attacks or strokes.
An imaging result is not a screening recommendation
The researchers also compared the imaging findings with SCORE2, a tool that estimates a person’s cardiovascular risk from factors such as age, smoking, blood pressure and cholesterol. SCORE2 classified only a small minority of participants with imaging-detected plaque as high risk, with the mismatch especially pronounced among younger people.
That gap raises a question the study did not answer: whether scanning people without symptoms and treating plaque found on images would prevent more heart attacks or strokes than current risk-based care. The published results describe baseline prevalence, not the benefits or harms of a screening program.
The investigators said prospective studies are needed and plan a randomized second phase to test an imaging-guided approach. The study was funded by the Novo Nordisk Foundation, and the ESC release lists lecture-fee disclosures for presenter Henning Bundgaard.
