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A landmark new study found silent atherosclerosis in 57% of healthy adults. At Impact Health, precision imaging like this has been the standard of care from day one — here’s why.
Most cardiovascular care is still built around a guess. Check cholesterol, blood pressure, smoking status, family history — run it through a risk calculator — and estimate the odds of a heart attack or stroke someday. It’s the model nearly every practice uses, and it’s the model we deliberately built Impact Health not to solely rely on.
From the start, our position has been simple: don’t estimate whether atherosclerosis might be there— look and find out. It’s why we equipped our practice with in-house coronary CT angiography (CCTA) and coronary artery calcium (CAC) scoring rather than sending patients out with a risk-score printout and a “check back in a few years.” A new landmark study just gave us the clearest evidence yet of why that distinction matters.
The old way misses more than half the picture
The REACT study, presented at the European Society of Cardiology Congress and published in the New England Journal of Medicine, imaged the coronary arteries of 16,808 adults ages 18 to 70 — none with known heart disease — using CCTA and 3-D ultrasound of the carotid and femoral arteries. Instead of estimating risk, investigators went looking for the disease itself.
What they found: 57% already had detectable atherosclerosis, with no symptoms to show for it. Among adults in their 20s, roughly 1 in 13 already had plaque — 8.7% of men and 6.7% of women — climbing to about 9 in 10 adults by their 60s. Men tended to develop plaque 5 to 10 years earlier than women, while women saw their sharpest rise during the menopausal transition, between roughly ages 40 and 60.
The finding that mattered most to us: traditional population-based risk calculators correctly flagged only a small fraction of these people as high-risk — and missed younger adults with silent disease almost entirely. In other words, the tool most of medicine still leans on would have told most of these patients they were “fine”.
This isn’t new territory for us — it’s the whole premise
This is precisely the gap Impact Health was built to close, and precision preventive cardiology has been our standard of care since we opened, not a response to one new headline. When appropriate, every patient’s evaluation goes beyond a risk score: CCTA to visualize both calcified and soft, non-calcified plaque years or decades before it could cause a symptom, CAC scoring, and advanced biomarkers layered with individual family history. That combination gives us a real picture of a patient’s coronary anatomy and plaque burden, not a probability.
REACT doesn’t prove everyone needs a scan, and it isn’t evidence that population-wide imaging screening reduces heart attacks and strokes on its own — that answer still needs prospective outcomes data. What it does confirm is the premise we’ve practiced on for years: a reassuring risk score and a clean bill of health are not the same thing, and the only way to know which one you actually have is to look.
What this means for you
If you’ve ever had a normal cholesterol panel and a low calculated risk score and wondered whether that’s the whole story, REACT suggests it might not be — and now you don’t have to wonder. Our approach was built around exactly this question, years before it had a landmark study behind it. The goal has never been to make you nervous about a number; it’s to give you and your care team an accurate picture early enough to act on it, so prevention means actually preventing.
The best time to find atherosclerosis is before it finds you. That’s not a new idea at Impact Health — it’s why we’re here.