Heart disease often starts decades before symptoms appear — and a major new study shows just how early.Researchers scanned more than 16,000 adults with no known heart disease, using imaging to detect silent atherosclerosis, plaque buildup in the heart, neck, and leg arteries.The results: more than half of all participants had the condition, which experts say is responsible for most cardiovascular deaths worldwide.Even more striking — 1 in 13 young adults, 18 to 29 years of age, already showed signs of disease. By ages 60 to 70, that number climbed to 9 in 10.Researchers also found the disease progresses differently by sex — appearing earlier in men but rising sharply in women around menopause.Perhaps most notable: the study showed standard risk scores based on blood pressure, cholesterol, and lifestyle factors missed most people who already had silent atherosclerosis — especially those younger adults.Researchers say handheld ultrasound scanners could help detect plaque that traditional risk assessments may not flag.They’re now planning a large clinical trial to see if this approach can slow the disease and help prevent heart attacks and strokes.Source: New England Journal of Medicine, ESC Congress 2026Author Affiliations: Copenhagen University Hospital, Centro Nacional de Investigaciones Cardiovasculares, Rigshospitalet, Hospital Universitario Fundación Jiménez Díaz, CIBERCV.Sign up for our weekly HealthDay newsletter