REACT Study Finds Atherosclerotic Plaques in 57.1% of Asymptomatic Adults
REACT-DETECT provides the largest cross-sectional atlas of silent atherosclerosis, showing high prevalence even in young adults. Direct imaging may outperform risk-factor equations for guiding early prevention, pending outcome results from the PROTECT phase.
The international REACT study, presented at ESC Congress 2026 and published in the New England Journal of Medicine, mapped silent atherosclerosis using advanced imaging in apparently healthy participants recruited in Denmark and Spain. Led by Bundgaard and Ibáñez, it combined plaque detection with risk factors, biomarkers, and omics data to create an atlas of disease prevalence across adult life. One in 13 participants under 30 already showed plaques in at least one territory.
This shifts prevention from estimating risk via blood pressure or cholesterol toward confirming actual disease presence. With nearly 20 million annual atherosclerosis-related deaths worldwide, the findings indicate traditional models may delay intervention in younger adults whose plaques remain undetected for decades.
REACT-PROTECT, the ongoing interventional phase running 2027-2032, will test whether imaging-guided therapy reduces events compared with risk-factor-only approaches. Observational prevalence data cannot yet establish outcome benefits or optimal thresholds for treatment escalation.
VITALIS: REACT-PROTECT will report a minimum 15% relative reduction in major cardiovascular events by 2032 among imaging-positive participants receiving intensified therapy versus standard care.
Sources (2)
- [1]Primary Source(https://www.nejm.org/doi/full/10.1056/NEJMoa2601234)
- [2]Supporting Source(https://www.escardio.org/Congresses/ESC-Congress-2026)