About one in three men and one in five women in Spain have atherosclerosis before the age of 40. They are unaware that they have damaged arteries because they do not yet have any symptoms, but they have a high risk of suffering a heart attack or stroke years later. In the age group of 40 to 50 years, the number of people with atherosclerosis rises to two-thirds of men and almost half of women.
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These are data from the largest study to date on the evolution of atherosclerosis throughout life, conducted with 16,808 people aged 18 to 70 from Spain and Denmark. The results were presented today at the European Society of Cardiology congress held in Munich and were simultaneously published in The New England Journal of Medicine. For the entire adult population, the number of people with atherosclerosis but without symptoms rises to 57%, with a higher incidence in men (63%) than in women (51%).
These data indicate that “early diagnosis of cardiovascular disease should begin before the age of 30,” says cardiologist Borja Ibáñez, scientific director of the National Center for Cardiovascular Research (CNIC) in Madrid and co-director of the research, to La Vanguardia. In cases where changes in diet and physical activity are not enough to control atherosclerosis, pharmacological treatment for cholesterol and/or hypertension should also begin at an early age.
Treatment would not necessarily have to be lifelong since, when atherosclerosis is detected and treated early, it is reversible, as demonstrated by previous CNIC research.
Atherosclerosis begins before age 30 in one in 11 men and one in 15 women
The project involved examining the arteries of the neck (carotids), groin (femorals), and heart (coronaries) of people without a history of cardiovascular disease. The carotids and femorals were examined with ultrasound, a harmless and affordable technique that can be applied on a large scale, while the coronaries were examined with computed tomography angiography (angio-CT), a more invasive and costly technique.
With these imaging techniques, they looked at which arteries had atheroma plaques, which are accumulations of fats, cholesterol, and inflammatory cells in the inner wall of the arteries and are responsible for strokes and heart attacks.
“The most important thing for the future is that the state of the carotids and femorals, which we can examine with simple and affordable technology, informs us about the state of the coronaries,” says cardiologist Valentín Fuster, general director of the CNIC and main promoter of this line of research, to La Vanguardia. “It will change the early diagnosis of cardiovascular disease; I think that within five to ten years it will be common to examine the carotid and femoral arteries of young adults,” adds Fuster, who is also the medical director of Mount Sinai Hospital in New York.
Approximately half of the study participants were from Spain and half from Denmark, with men and women equally represented. The study, called REACT and funded by the Novo Nordisk Foundation with 23 million euros, has been led in Spain by the CNIC and in Denmark by the Copenhagen University Hospital.
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The CNIC develops an ultrasound to examine blood vessels simply and affordably
The results have been similar in both countries. 8.7% of men (one in eleven) and 6.7% of women (one in fifteen) are affected by atherosclerosis before age 30 — that is, they have atheroma plaques in at least one of the arteries examined. The percentage increases with age and reaches 99% of men and 92% of women in the 60-70 age group.
The strategy proposed by the CNIC team to improve early diagnosis of atherosclerosis is based on offering ultrasounds of the two carotid and two femoral arteries to people of any age who have abnormal cholesterol or blood pressure values. If atheroma plaques are detected, the first intervention will be to modify health habits to improve diet and practice physical activity. If after six months excessive cholesterol or blood pressure levels persist, medication would be prescribed without the need for new ultrasounds.
“There are people who have atheroma plaques in the femorals but not yet in the carotids, and vice versa; to make a good early diagnosis we will have to look at both,” says Borja Ibáñez.
The research used a high-resolution 3D ultrasound technique. To enable large-scale application, the CNIC team is developing a portable AI-assisted ultrasound that does not require expert personnel. It can be used outside healthcare centers — for example, in pharmacies or companies — and in both rich and poor countries. The technology, still experimental, will begin to be used in the coming months in Mexico, India, and Spain. “Our goal is to have it ready by 2027 and facilitate its widespread use,” says Ibáñez. The project is funded by Philips, Zeiss, Novo Nordisk, and the Ministry of Digital Transformation.
“Atherosclerosis is common in apparently healthy people,” adds the cardiologist. “We have to change the criteria for assessing cardiovascular risk, which assign a low risk to young people. We know that early intervention is beneficial for people with atherosclerosis. We need earlier diagnosis to be able to intervene sooner.”
Valentín Fuster: “Health education must start in school”
The discovery that a large number of young adults have damaged arteries “reinforces the idea that prevention must start in childhood by instilling healthy habits in early childhood and primary education stages,” says cardiologist Valentín Fuster, general director of the National Center for Cardiovascular Research (CNIC). Through the SHE Foundation, Fuster has developed educational programs in schools in Spain, the United States, and Colombia. These programs, which are not limited to diet and physical activity but emphasize knowledge of one’s own body and emotion management, have improved students’ knowledge, attitudes, and habits regarding their health.
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