Heart attacks and strokes can feel like they come out of nowhere. But the changes inside your arteries that can lead to them usually build up slowly, over many years. New research published in The New England Journal of Medicine suggests those changes may start much earlier than most people think — even in young adulthood.
The study found silent atherosclerosis, or plaque buildup in the arteries that causes no noticeable symptoms, in more than half of the adults ages 18 to 70 studied. Importantly, signs of atherosclerosis were detectable in about 1 in 13 people ages 18 to 29. The findings are a reminder that cardiovascular health deserves attention well before symptoms develop.
So what is atherosclerosis, why can it go unnoticed and what can you do to protect your arteries?
What the NEJM Study Found
Researchers in the study looked at 16,808 adults between ages 18 and 70 in Denmark and Spain. None had known cardiovascular disease. Using advanced imaging, the team checked for plaque in arteries in the neck, legs and heart.
Here’s what they discovered:
- 57.1 percent of participants had signs of atherosclerosis
- Among adults ages 18 to 29, plaque was found in 8.7 percent of men and 6.7 percent of women
- Atherosclerosis became more common and more extensive with age
- Plaque appeared earlier in men, while women had a steeper rise during midlife
In younger adults, plaque was usually found in one area, often in the arteries of the legs. In older adults, plaque was more likely to be found in several areas of the body.
What Is Atherosclerosis?
Atherosclerosis happens when plaque builds up inside the walls of your arteries. Think of your arteries like flexible pipes that carry blood around your body. Plaque — made of cholesterol, fat, calcium and other substances — can gradually build up along the artery walls, making them narrower and stiffer and making it harder for blood to flow.
Atherosclerosis can affect arteries throughout the body:
- When plaque slows blood flow to the legs, it can cause peripheral artery disease (PAD).
- When plaque builds up in the arteries that supply the heart, it can lead to coronary artery disease.
- When plaque builds up in the carotid and cerebral arteries (that supply the brain), that can increase your risk of stroke.
The broader term atherosclerotic cardiovascular disease refers to cardiovascular conditions caused by atherosclerosis.
Why Can It Go Unnoticed?
One challenge with atherosclerosis is that you may not know you have it. Early on, it usually causes no symptoms.
As plaque grows, some people may develop symptoms related to reduced blood flow. In the heart, narrowed arteries can cause chest pain or pressure, especially during exercise. A sudden blockage can trigger a heart attack.
That is why prevention is so important. You don’t have to wait for symptoms to start paying attention to your cardiovascular health.
What Raises Your Risk?
It is important to realize that not everyone has the same level of risk. Several factors can increase your risk of atherosclerosis — some you can change, while others, such as age and family history, you cannot. Atherosclerosis develops over time, and your overall risk depends on a combination of these factors.
Common risk factors include:
- High LDL (“bad”) cholesterol
- High blood pressure
- Diabetes or high blood sugar
- Smoking
- Lack of physical activity
- Carrying extra weight
- An unhealthy diet
- A family history of heart disease
- Age
The new study also found an interesting difference between men and women. Plaque appeared earlier in men, while women had a later but steeper rise during midlife. This increase occurred during midlife, a period that often overlaps with the menopausal transition, but more research is needed to understand the reasons for this difference.
How Can You Protect Your Arteries?
Protecting your heart and blood vessels starts with managing your cardiovascular risk throughout life. Some of the most important steps include:
- Get regular checkups. Routine visits give you a chance to check your blood pressure, cholesterol and blood sugar and talk with your healthcare provider about your heart health.
- Stay active. Regular physical activity can help manage several cardiovascular risk factors.
- Eat for heart health. Choose plenty of vegetables, fruits, whole grains, beans and nuts, and limit saturated fats, added sugars and sodium.
- Avoid tobacco. Not smoking and avoiding secondhand smoke can lower your cardiovascular risk.
- Take medications as prescribed. If you have high cholesterol, high blood pressure or another condition that increases your cardiovascular risk, take medications as directed by your healthcare provider.
- Know your family history. A family history of early heart disease may mean you need to pay closer attention to your cardiovascular risk.
What This Research Means for You
The key message from this study is not that you need a scan to look for plaque. It is that atherosclerosis can begin silently, long before warning signs appear. Taking steps to protect your heart throughout your life can help lower your risk of cardiovascular disease.
If you have questions about your risk for cardiovascular disease, talk with your healthcare provider about the steps that are right for you.
