An unprecedented, large-scale study revealed that the dreaded fatty plaques in the arteries, which can lead to events such as heart attack and stroke, already appear in young adults aged 20 and over. Research shows that, by the age of 40, around half of men and a third of women already live with atherosclerosis, often without any knowledge about the condition.
The data were released at the end of August at the European Cardiology Congress, held in Munich, Germany, considered the largest event in the specialty in the world. The complete results were simultaneously published in the renowned scientific journal “New England Journal of Medicine” on September 1, 2026, indicating a milestone in understanding the onset of the disease.
The unexpected discovery of plaques in young people
The survey involved 16,808 individuals, aged between 18 and 70 years. It is crucial to note that none of the participants had a history of heart attack, stroke or previous arterial obstructions, which makes the discovery even more shocking. The main surprise was not just the prevalence of the plaques, but the precocity of their appearance.
In the 18 to 29 age group, considered low risk, 8.7% of men and 6.7% of women already had at least one compromised artery. This means that approximately one in every 13 young people at this age already carried initial and silent signs of a process that can worsen over the decades, culminating in a heart attack.
Elzo Mattar, director of the Arterial Hypertension Department of the Brazilian Society of Cardiology (SBC) and professor at the State Faculty of Medicine of São José do Rio Preto (Famerp), stated that these numbers caused “discomfort” among specialists in Munich, as the incidence at such a young age was not expected.
Atherosclerosis progresses silently and progressively
The study highlighted that atherosclerosis is a disease that progresses without obvious symptoms in its initial stages. The plaques were identified through detailed imaging tests carried out on participants who did not feel any discomfort.
The procedures included three-dimensional ultrasound of the carotid arteries, located in the neck, three-dimensional ultrasound of the femoral arteries, in the groin, and CT angiography of the coronary arteries, which are the vessels responsible for irrigating the heart.
From the age of 30, the prevalence of the disease increases exponentially, showing an accelerated progression with age:
- Between 30 and 39 years old, plaques were detected in 34.6% of men and 21.3% of women.
- By the age of 40, approximately half of men and 30% of women already had fatty deposits in some artery.
- In the 60 to 70 age group, the presence of atherosclerosis becomes almost a rule, with only 1.9% of men and 8.1% of women without detectable plaques.
With advancing age, the disease also changes its characteristics. Plaques tend to become more voluminous, richer in fat and spread across different regions of the arterial system, not being restricted to a single point.
Understand the formation of fatty plaques in the arteries
Atherosclerosis is defined as a chronic disease characterized by the accumulation of cholesterol and inflammatory processes in the artery walls. These fatty deposits gradually narrow the blood vessels, decreasing blood flow.
LDL cholesterol, popularly known as “bad cholesterol”, plays a central role in this process. It is a particle that transports cholesterol through the blood. When there is an excess of LDL particles in circulation, the likelihood of them infiltrating the inner layer of the arteries, becoming trapped in their walls, increases.
This retention triggers an inflammatory response, with the body interpreting the oxidized cholesterol as a foreign body. Defense cells are sent to combat this “invasion”, engulfing cholesterol and transforming into “foam cells”. This continuous inflammatory cycle contributes to plaque growth.
Mattar describes the accumulation as a chain reaction that is completed when two conditions combine: an injury to the endothelium (the thin layer that lines the inside of the vessels) and high cholesterol levels. If the inflammation in the plaque worsens, the protective layer that separates it from the blood can break, forming a clot (thrombus) that blocks the vessel. This blockage can result in a heart attack, if it occurs in the coronary arteries, or a stroke, if it affects a cerebral artery.
Why does atherosclerosis appear so early?
The presence of plaques at age 20 raises the question of the factors that contribute to this early onset. Ricardo Kazunori, cardiovascular surgeon at BP – A Beneficência Portuguesa in São Paulo, explains that the cause is a combination of genetic inheritance and lifestyle, with a significant weight of the hereditary component.
Some people have a genetic predisposition that makes cholesterol metabolism difficult, resulting in high LDL levels from a young age. If this genetic condition is combined with unhealthy lifestyle habits, the problem is exacerbated.
Mattar adds that the process can even begin before birth. Depending on the mother’s diet and cholesterol levels, the first fatty streaks may appear in the fetus’s arteries while still in the womb.
Several factors attack the blood vessel wall and can trigger the disease:
- High blood pressure (hypertension)
- Diabetes
- Obesity, especially visceral obesity (which involves the abdominal organs and generates a chronic inflammatory state)
- Smoking
- Air pollution
Cigarettes, for example, induce the formation of plaques even without containing fat. Substances such as nicotine damage the endothelium, opening the way for cholesterol to settle and start the atherosclerosis process.
Implications of early discovery and the path to prevention
The good news, however, is that early detection of fatty plaques in young people is not a sentence, but a warning. According to Mattar, the chance of a young person having a heart attack shortly after diagnosis is “practically zero”, as long as he adopts measures to control risk factors. The exceptions are behaviors that accelerate the disease, such as the use of anabolic steroids and stimulant drugs.
The main concern lies in the long term. A young person with subclinical atherosclerosis — that is, a person with the disease that has not yet manifested itself — is classified in a higher cardiovascular risk range. This requires greater care, with stricter goals for controlling cholesterol, blood glucose and blood pressure.
If preventive measures are not taken, the disease is progressive. Existing plaques can grow and new ones can emerge, increasing the risk of heart attack and stroke within a few decades. The study also reinforces the importance of evaluating peripheral arteries, such as the carotid and femoral arteries, as they reflect what is happening in the heart. Almost 80% of people with plaques in their coronary arteries also had them in other vessels.
Different rhythms of atherosclerosis between men and women
Researchers observed that men develop atherosclerosis 5 to 10 years earlier than women. This difference is attributed to hormones, especially female estrogen, which exerts a protective effect on blood vessels.
For this reason, a woman’s cardiovascular risk begins to increase significantly from the age of 40, the climacteric period, when estrogen levels decrease. After age 60, the risk for women tends to equal that of men.
Mattar warns that this transition period requires extra attention to heart health. Hormone replacement, when there are no contraindications, may be an option, as long as it is started within an “ideal window” in the first few years after the hormone drop.
Prevention Starts Early: What You Can Do
Given the results, cardiologists’ recommendation is not to order imaging tests for all young people. Mattar explains that it would be “too onerous” and would not change the initial approach, which is to investigate risk factors and promote lifestyle changes.
In practice, the prevention of atherosclerosis should begin around the age of 20, focusing on the search for silent risk factors, such as high blood pressure, diabetes and high cholesterol. Key recommendations include:
- Perform at least 150 minutes of moderate physical activity per week.
- Maintain a balanced diet, with less saturated fat and sodium.
- Quit smoking and excessive alcohol consumption.
Kazunori makes an exception for individuals with a strong family history of early heart attacks. In these cases, a carotid and femoral ultrasound may be beneficial to assess atherosclerotic burden. If it is elevated, strict control of LDL cholesterol, with possible medications such as statins, and a reclassification of risk become necessary.
The Brazilian scenario: a warning about lifestyle habits
Although the study was carried out with populations from Spain and Denmark, which prevents direct extrapolation to Brazil, Elzo Mattar issues a warning. Considering the Brazilian reality, marked by an often unbalanced diet and high rates of sedentary lifestyle, it is likely that the situation of early atherosclerosis in the country is even more worrying.
This context reinforces the urgency of public policies and awareness campaigns that promote healthy habits from childhood. Understanding that cardiovascular disease begins long before the first symptoms appear is crucial to encouraging active prevention across all age groups.
Cardiologists are keen to emphasize that, despite the scare that these data may cause, there is no room for fatalism. Many of the factors that drive the disease, such as weight, smoking and sedentary lifestyle, depend on daily choices. Even family inheritance is often “activated by the lifestyle the person leads”, according to Mattar. Having parents with high blood pressure, for example, increases the chance of someone becoming hypertensive, but factors such as excess salt, weight gain and alcohol consumption can trigger this gene.
The main conclusion of the study and the lesson for public health is the importance of intervening while fatty plaque is just a finding on exams, and not an imminent threat to life. Prevention is the most powerful tool against the silent advancement of atherosclerosis.
