"In the paradigm we propose, portable ultrasound devices usable by any healthcare professional will become the standard tool for atherosclerosis screening from the early stages of adult life."

How do men and women differ?

The study surfaced a clear sex gap in timing. Men's plaque prevalence began climbing at younger ages, putting their overall pattern roughly 5 to 10 years ahead of women's. Women's sharpest rise occurred between ages 40 and 60, a window that lines up broadly with the menopausal transition. The team argues that prevention strategies must be tuned to both sex and life stage.

Can current risk calculators catch this disease?

Standard tools, including the SCORE2 risk score used across Europe, identified only a small fraction of the participants who actually harbored silent atherosclerosis. A person can look low-risk on paper while plaque quietly accumulates. Professor Henning Bundgaard, a cardiologist at Copenhagen's Rigshospitalet who co-led the work, said the findings warrant a rethink:

"Until now, preventive decisions have been based on an estimate of risk, but we did not know whether the disease was already present."

Dr. Ibáñez pushed the point further: "For decades, we have estimated cardiovascular risk using factors such as age, blood pressure and cholesterol. This study shows that we can now go one step further and detect the disease directly before it causes a heart attack or stroke."

What comes after Phase 1?

The Novo Nordisk Foundation is funding REACT's first phase for up to EUR 23 million. The full project is planned to run eight years. Phase 2, REACT-PROTECT, is slated for 2027 through 2032 if further funding is approved. It would test, through a large randomized trial, whether an imaging-guided prevention strategy can slow atherosclerosis progression and cut cardiovascular events better than today's risk-factor approach.

The team is also extending the work globally. Close collaborations are underway with partners in India, Singapore, Tanzania, and Mexico to validate the European findings in populations with different genetic and environmental backgrounds.

How does REACT connect to earlier work?

REACT builds on PESA-CNIC-Santander, an earlier CNIC-led study under Dr. Valentín Fuster that linked widespread atherosclerosis in middle-aged adults to lifestyle patterns. REACT pushes the search downward into the 18-to-29 age group, where the disease had rarely been imaged before. Fuster, Director General of CNIC, said the earlier work raised one big question: "In REACT, we wanted to investigate how it emerges at much younger ages. For years, we have proposed that early intervention in atherosclerosis could not only prevent its progression but might even make it possible to cure the disease."

What are the limits?

The results, while large, come from only two European countries. Prevalence numbers may shift once REACT's global partners contribute data. Phase 1 was observational; whether catching silent atherosclerosis early actually improves survival remains untested, which is exactly what REACT-PROTECT aims to find out.