REACT imaging finds silent artery disease in 57.1 per cent of symptom-free adults
The European Society of Cardiology and EMJ Reviews scanned 16,808 symptom-free adults aged 18-70 from Denmark and Spain with multimodal imaging; silent atherosclerosis was found in 57.1 per cent of those scanned. The finding was present in about 1 in 13 adults aged 18-29 and 9 in 10 aged 60-70. The SCORE2 risk tool classified only a small minority of those with silent disease as high risk. The results were presented at ESC Congress 2026.
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Silent artery disease showed up in 57.1 per cent of symptom-free adults
The REACT Initiative scanned 16,808 symptom-free adults aged 18-70 from Denmark and Spain with a mean age of 45. Carotid and femoral arteries were imaged with three-dimensional vascular ultrasound and coronary arteries with CT angiography. Silent atherosclerosis was found in 57.1 per cent of those scanned. EMJ Reviews stresses that multimodal imaging revealed a widespread silent burden in symptom-free adults. The European Society of Cardiology says early imaging identified silent disease not captured by conventional risk assessment. The results were published in the New England Journal of Medicine as they were presented at the ESC Congress in Munich.[1], [2]
Prevalence rose from one in 13 at 18-29 to nine in ten at 60-70
Atherosclerosis was present in about 1 in 13 of those aged 18 to 29 and in 9 in 10 aged 60 to 70. EMJ Reviews reports the finding rose sharply with age; coronary arteries were assessed with CT angiography and calcium scoring. The REACT Initiative says prevalence rose earlier in men, while women showed a later and steeper increase around the usual age of menopause. The European Society of Cardiology says the SCORE2 risk tool classified only a small minority of the adults who had silent disease as high risk, and hardly any of the younger ones.[1], [2]
A second phase will test imaging-guided treatment
This first phase of REACT is described as observational and cross-sectional; the initiative says a follow-on study of imaging-guided treatment is planned for its second phase. EMJ Reviews reports the scan of 16,808 adults was presented at ESC Congress 2026. The European Society of Cardiology stresses that early imaging revealed silent disease while existing risk tools missed most of it. The concrete message for clinicians is that artery hardening is widespread in symptom-free adults, yet standard risk scores do not label most of it high risk.[1], [2]
