Silent Atherosclerosis Common in Early Adulthood and Progressively Worsening with Age

Silent atherosclerosis was detectable as early as young adulthood and became progressively more prevalent and extensive with age, with a later and steeper increase among women. In this prospective cohort study conducted in Denmark and Spain, 16,808 adults aged 18 to 70 years without known atherosclerotic cardiovascular disease underwent three-dimensional vascular ultrasonography of the carotid and femoral arteries and coronary computed tomographic angiography. Overall, silent atherosclerosis was present in 57.1% of participants; even at 18 to 29 years of age, it was detected in 8.7% of men and 6.7% of women. Prevalence increased with age, with women showing a later but steeper rise during midlife. In younger adults, disease was usually peripheral and limited to a single vascular territory, whereas increasing age was associated with an exponential increase in plaque volume and more frequent involvement of multiple arterial territories. Isolated coronary-artery atherosclerosis remained uncommon across all age groups, occurring in no more than 9.3% of men and 5.0% of women. These findings show that atherosclerosis can begin silently in early adulthood and progressively increase in prevalence, vascular distribution, and plaque burden across the adult lifespan. Source: https://www.nejm.org/