One-Third of Men in Their 30s Show Hidden Heart Disease

Picture this: a person in their thirties, fit on paper, no chest pain, no shortness of breath — and still, dangerous plaque is quietly lining their arteries. It sounds like bad luck. But a new, large-scale imaging study suggests it’s more common than most of us expect.

Researchers examining nearly 17,000 adults aged 18 to 70 across Denmark and Spain found signs of atherosclerosis — the slow build-up of fat and cholesterol in artery walls — in more than 57 percent of participants. The investigation, led by Henning Bundgaard at Copenhagen University Hospital and Borja Ibáñez at Spain’s National Center for Cardiovascular Research, used ultrasound and CT angiography to scan three key vascular territories: the carotid arteries in the neck, the femoral arteries in the legs, and the coronary arteries that feed the heart.

Notably, among the 13,186 volunteers who received full imaging, even the youngest adults weren’t immune: about one in 13 people aged 18 to 29 showed detectable plaque. The numbers climb steadily with age. In the thirties, roughly 34.6 percent of men and 21.3 percent of women had visible plaque. Men tended to show signs about five to ten years earlier than women, though women experience a sharper rise in midlife. By the time people reach their sixties, almost everyone displays some degree of arterial plaque — only 1.9 percent of men and 8.1 percent of women aged 60–70 had entirely plaque-free vessels.

Severity tracked with age, too. Finding plaque in multiple vascular regions was relatively rare in people in their thirties. But in the 60–70 age group, more than half of men and roughly one-third of women had plaques in all three examined territories. That kind of widespread disease changes the picture of what “getting older” means for vascular health.

A striking corollary: conventional risk calculators can miss this hidden burden. Tools like SCORE2, which estimate ten-year cardiovascular risk from factors such as age, blood pressure, cholesterol, and smoking, failed to flag many people who already harbored silent atherosclerosis on imaging. In short, lab numbers and risk scores don’t always tell the whole story.

Does this mean everyone should have CT scans and carotid ultrasounds? Not necessarily. The investigators stress that the study’s value lies in mapping how atherosclerosis develops over the life course rather than issuing a blanket screening recommendation. It remains unclear whether widespread imaging would actually prevent more heart attacks and strokes than current prevention strategies.

The team plans to test the next logical question: if we detect plaque earlier, and act early with targeted prevention, will outcomes improve compared with standard risk-based care? That trial will be the one to watch.

For now, the take-home is simple and unsettling: heart disease rarely begins the moment symptoms appear. Often, it has been growing in silence for years, a slow and steady process that only becomes obvious when we look closely.

Published in the New England Journal of Medicine, this study nudges clinicians and the public alike to reconsider when and how we search for the first signs of cardiovascular trouble — and asks whether earlier detection could change the story.