The artery plaque that builds while you feel fine

Most of us think of clogged arteries as a later-life problem — something to worry about after years of high cholesterol, high blood pressure or weight gain.

But feeling healthy can give us a false sense of security.

You can go about your day without chest pain or obvious circulation problems while plaque quietly builds up inside your arteries.

New findings from the international REACT study reveal just how common that hidden buildup can be — and why waiting for symptoms could mean missing years of opportunity to protect your arteries.

Quick Answer

Silent atherosclerosis is artery plaque that develops before symptoms appear. REACT detected it in 57.1% of participants without known atherosclerotic cardiovascular disease, including some under 30. The findings support addressing cardiovascular risks early, even when you feel healthy.

What the REACT study found

Published in The New England Journal of Medicine, the study included 16,808 adults aged 18 to 70 in Denmark and Spain.

Researchers examined the carotid arteries in the neck and femoral arteries in the legs with three-dimensional ultrasound. They used coronary CT angiography, or CCTA, to examine the arteries supplying the heart.

Unlike a coronary artery calcium scan, which measures calcified plaque, CCTA can also reveal noncalcified plaque.

About 1 in 13 participants aged 18 to 29 had plaque in at least one artery. Among those aged 60 to 70, that rose to roughly 9 in 10.

In younger participants, plaque was usually limited to one vascular territory, most often in the neck or legs. Older groups had substantially greater plaque volume and more frequently involved multiple territories.

These findings compare baseline scans across age groups rather than tracking individual plaque growth over decades. But they show how early the process can already be underway.

Why midlife deserves attention

Men’s plaque patterns appeared roughly 5 to 10 years earlier than women’s. Women’s plaque increased most steeply between ages 40 and 60, broadly overlapping the menopause transition. That overlap does not establish that menopause caused the increase.

Plaque danger also goes beyond how much an artery has narrowed. As we’ve covered, the artery plaque most likely to trigger a heart attack is fatty and vulnerable, and it can rupture and trigger a clot.

For readers in midlife and beyond, that makes prevention worth revisiting even when nothing feels different.

Why risk scores cannot tell the whole story

Conventional risk scores identified only a small proportion of participants with silent plaque, according to CNIC.

Those scores estimate the likelihood of future cardiovascular events; they do not directly inspect artery walls.

Most participants with coronary plaque also had plaque in their neck or leg arteries, suggesting ultrasound could potentially help guide prevention.

A proposed second REACT phase, contingent on funding, would test that approach. This report does not establish that scanning everyone prevents heart attacks or strokes.

Three specific ways to give your arteries attention

Start by reviewing your blood pressure, LDL cholesterol, triglycerides and blood sugar with your clinician. Then consider these findings from previous research:

• Put carotene-rich foods on your plate. Carrots, sweet potatoes, pumpkin, spinach and kale provide antioxidant compounds called carotenes. In a study of 204 adults, higher blood carotene levels were associated with less plaque in the carotid arteries. After accounting for other factors, the association remained significant in women. Our earlier report on carotenes and atherosclerosis helps explain this connection.
• Keep your sleep schedule steady. Your arteries may care as much about consistency as they do about hours. A study of more than 2,000 older adults found that people with the most irregular sleep duration were 33% more likely to have a high coronary artery calcium score — a measure of calcified plaque — than those with more consistent sleep. The association persisted after accounting for average sleep duration and other sleep problems. Keep bedtime and wake-up time reasonably consistent, including on weekends. Read more about the connection between irregular sleep and artery plaque.
• Consider the research on aged garlic extract. In a small randomized trial, 55 adults with metabolic syndrome received 2,400 mg daily or placebo for approximately one year. Aged garlic significantly reduced low-attenuation plaque — the lipid-rich type of noncalcified plaque associated with greater heart attack risk. The benefit applied only to that plaque component, not to a significant reduction in total plaque. That makes aged garlic worth discussing as part of a broader artery-protection plan.

The carotene and sleep studies identified associations, while the garlic trial tested a treatment. None establishes that these steps alone prevent heart attacks.

If prevention decisions remain uncertain, ask whether a coronary calcium scan would help clarify them. Current guidance supports selective use when estimated cardiovascular risk is borderline or intermediate.

Feeling fine is not the same as being plaque-free. Knowing that gives you a reason to act while your arteries are still keeping their troubles quiet.

Sources:

Prevalence of Silent Atherosclerosis across Adult Life — The New England Journal of Medicine

REACT reveals that silent atherosclerosis already affects 1 in 13 young adults aged 18 to 29 — CNIC

Total carotene plasma concentrations are inversely associated with atherosclerotic plaque burden: A post-hoc analysis of the DIABIMCAP cohort — Clinical Nutrition

Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis — Journal of the American Heart Association

Aged Garlic Extract Reduces Low Attenuation Plaque in Coronary Arteries of Patients with Metabolic Syndrome in a Prospective Randomized Double-Blind Study — The Journal of Nutrition

ACC, AHA Release New Clinical Guideline for Managing Dyslipidemia — American College of Cardiology

FAQ: What To Know About Silent Artery Plaque