‘Silent Atherosclerosis’ Can Be Especially Deadly for Young People, Study Finds

A young woman checks her blood pressure.
Young adults should monitor their blood pressure and cholesterol levels to assess any future risk of atherosclerosis, a new study reports. Nikola Stojadinovic/Getty Images
  • A new study finds risk factors like high cholesterol and high blood pressure should be addressed earlier in life to help prevent atherosclerosis.
  • Atherosclerosis is a hardening of the arteries due to plaque buildup from calcium, fats, and cholesterol.
  • The condition can drastically increase the risk of cardiac events including stroke and heart attack.

Atherosclerosis is a hardening of the arteries due to plaque buildup from calcium, fats, and cholesterol that can lead to blood clots, stroke, and heart attack or heart failure. It has commonly been associated with older adults.

But a new study published Monday outlines an increased risk to younger adults for so-called “silent atherosclerosis,” suggesting that risk factors like high cholesterol and hypertension should be addressed earlier in life to prevent the disease from developing further.

The study, carried out at Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC) and published in the Journal of the American College of Cardiology, analyzed the key arteries including the carotid, femoral, and coronary arteries and aortas of more than 4,000 healthy middle-aged employees of a bank in Madrid.

The researchers found that even moderate increases in blood pressure and cholesterol were shown to significantly impact the risk of atherosclerosis in younger adults.

At what age should blood pressure and cholesterol be checked?

Risk factors like high cholesterol and hypertension can affect younger adults’ chances of atherosclerosis later in life more than previously known.

Testing earlier in life (between the ages of 20 and 25) and aggressively mitigating risk is beneficial, Dr. Borja Ibáñez, the scientific director of CNIC and one of the authors of the study, told Heathline.

“Given these findings, it would be worthwhile for healthcare professionals to start assessing cardiovascular risk earlier on, including during check-ups in early adulthood,” Dr. Rigved Tadwalkar, a cardiologist at Providence Saint John’s Health Center in Santa Monica, Calif., told Heathline. “This approach is consistent with the idea of early intervention and aggressive control of cardiovascular risk factors as a means for reducing cardiovascular disease burden.”

What age groups are most at risk for atherosclerosis?

Given the physiological changes that come with aging, older adults are still at the highest risk, Tadwalkar said.

“This includes arterial stiffening, atherosclerosis progression, and increased vulnerability to oxidative stresses and inflammation. The cumulative exposure to risk factors, such as high blood pressure and cholesterol, further amplifies cardiovascular risk as people age,” Tadwalkar noted.

But the study suggests that even seemingly healthy younger adults should be monitored for risks associated with cardiovascular disease, Tadwalkar said, adding that genetic traits can play a role.

“We know that those with a family history of cardiovascular diseases may face an increased risk, additionally warranting early testing and vigilant monitoring, especially considering that the progression of atherosclerosis is often silent,” he said.

But younger adults seeing higher LDL (low-density lipoprotein) cholesterol levels and blood pressure results at their yearly physicals should take note, Ibáñez warned. LDL cholesterol is commonly termed as “bad” cholesterol.

“We know that those who have higher LDL-cholesterol levels and blood pressure above the ideal values and smokers are at the higher risk for having early onset and progression of atherosclerosis,” Ibáñez said.

“Still, future studies we are running should clearly delineate this in even younger populations.”

What are the warning signs of atherosclerosis?

There are a number of other lifestyle-related signs that can suggest an elevated risk for atherosclerosis.

A 2022 study listed a number that should be monitored for adults between the ages of 20 and 39:

  • tobacco use
  • high blood pressure
  • hypertension
  • family history of atherosclerosis
  • diabetes
  • preeclampsia
  • menopause in females under 40

A number of sleep disorders can also play a role. Obstructive sleep apnea, which can affect nearly a quarter of American adults between the ages of 30 and 70, can significantly increase the risk of cardiovascular disease.

“Sleep apnea, and poor sleep quality more generally, are emerging as noteworthy factors. Disrupted sleep patterns can lead to increased stress on the cardiovascular system,” Tadwalkar said.

“This underscores the importance of considering holistic factors in assessing and managing cardiovascular health.”

How can you protect yourself from atherosclerosis?

High cholesterol and blood pressure conditions can be initially controlled with a combination of a healthy diet, regular exercise, and prescription drugs as directed by a physician. Adjusting sugar intake and quitting smoking are also extremely important, Ibáñez said.

Such a multifaceted approach is “essential,” Tadwalkar added, but getting a sense of the risk factors early is increasingly important.

“Health check-ups and screenings are critical for early detection of risk factors,” Tadwalkar said.

“This can also help identify individuals who need to move beyond lifestyle modifications alone and into pharmacological interventions, such as cholesterol-lowering medications or antihypertensive drugs.”

Tadwalkar suggested that personalized approaches like imaging technology can be used as needed to monitor the presence and development of silent atherosclerosis.

“This allows for tailored interventions based on individual risk profiles” he said. “Regular follow-up with a physician is essential to assess the effectiveness of interventions and make appropriate adjustments, as needed.”


Atherosclerosis can lead to stroke, heart attack, and heart failure.

Adults as young as 20 should have regular physicals and monitor their blood pressure and cholesterol levels to assess any future risks of atherosclerosis.

Anyone with a family history of atherosclerosis, a regular tobacco habit, poor diet, lack of exercise, or sleep disorders like apnea should have their risks assessed earlier than previously thought.

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