Sep 30, 2021 5 min read

A new study in the scientific journal Circulation shows many middle-aged adults with no history of heart trouble already have fatty deposits built up in their arteries.

The study assessed 25,000 people ages 50 to 64 in Sweden and found 42% of them had signs of atherosclerosis, which is a buildup of plaque in the arteries. The Swedish test subjects had no history of heart attack or any procedures to clear clogged arteries and had two different imaging tests.

The first, coronary artery calcium screening, looks for calcium deposits in heart arteries that can cause hard plaque buildup.

The second test, CT angiography, combines a CT scan with an intravenous injection of dye to show pictures of blood vessels and can detect soft plaque buildup.

Results show 42% of those in the study had some degree of buildup or atherosclerosis. The study’s authors said those with very high calcium scores all showed evidence of atherosclerosis on their CT angiography. Of those with calcium scores of zero, 5.5% of those tested also had some degree of the buildup on angiography.

“In terms of their demographic and patient population, I think in some ways they represent Americans,” said Dr. Travis Wilson, cardiologist with Allegheny Health Network and the Cardiovascular Institute at Canonsburg Hospital. “In some ways they differ, probably with respect to diet and potentially with respect to lifestyle. We would consider them maybe a more active society.”

Wilson believes the same type of study in the United States would show even worse results.

“By nature of our diet and lifestyle in this country, it’s more prevalent at a younger age,” he said. “I would submit that if you did similar registry study in America, probably the numbers would all be higher. Rather than 42%, I think this country would be more like 70%.”

Wilson said the study results did not surprise him.

“Actually, it kind of validates what a lot of healthcare professionals advocate and recommend to their patients,” he said. “In general, I say to my patients, most Americans, by the age of 50, probably have a buildup of blockage to some degree somewhere in one of the arteries on top of their heart and one of their coronary arteries. This study just kind of validates that.”

Wilson said the two tests used in the study are increasingly available and he performs the CT angiography at Canonsburg Hospital.

“I’m a big fan of both tests,” he said. “The first one is the coronary calcium score which is basically just a CT scan of your heart. They don’t use any IV dye, and it takes all of five minutes to get that test done.”

The results show if the patients has some degree of blockage or absolutely nothing.

Wilson said the limitation of that test is plaque blockages in the arteries.

“Plaque comes in two flavors, either calcified plaque or soft plaque,” he said. “The coronary calcium score will only pick up on calcified plaque. In general, more unstable plaques tend to be soft and so those are the ones that you would expect to cause symptoms.”

Wilson said that test helps him decide how aggressive to be with risk-factor modification in asymptomatic patients who have moderate risk.

“I do actually order this test quite a bit and I do usually order it in asymptomatic patients,” he said.

The second test in the study is more expensive and more involved.

“The coronary CTA does involve using IV dye,” Wilson said. “It takes 45 minutes to an hour and a half and it can pick up on this soft plaque.”

One fact from this study did surprise Wilson.

“If anything in the article that I found surprising was actually that 5% of people who had a normal coronary calcium score were found to have disease on the coronary CTA. I was surprised by that,” Wilson said. “The coronary CTA has evolved quite a bit and really is almost as diagnostic as a heart catheterization depending on which scanner you have that study performed on.”

Despite that finding, Wilson does not recommend everyone run to their doctor and ask for these tests.

“If you smoke or have smoked a significant amount in the past, if you have diabetes, or if you have a family history of premature coronary artery disease, those are kind of the three risk factors where it would be reasonable to get a coronary calcium score, even in the absence of any symptoms,” Wilson said.

To lower the risk of atherosclerosis leading to a heart attack or stroke, patients can take steps to control high blood pressure and blood-sugar levels, lower their cholesterol, quit smoking, eat a healthy diet and get plenty of exercise.

“Regardless of your risk factors, once you’re to the age of 50 or even younger, we always recommend a heart healthy diet and to live an active lifestyle with exercise at least 30 minutes a day, three times a week and, ideally, more than that,” Wilson said. “This study supports that there’s an increased incidence of heart disease, so all the more reason to try to reduce your risk.”

Wilson said having some of this plaque building may be more common as we age, but it doesn’t always have to happen.

“I always say to people, you know, even though most Americans by the age of 50 have a little buildup somewhere, it’s still not a normal part of aging,” he said. “It is more common as we age, but it’s not a normal part of aging.”