Cardiovascular Health 2026

Key Takeaways

• 63% of 40‑54 year-olds have subclinical plaque (PESA)
• 42% of 50‑64 year-olds show coronary atherosclerosis (SCAPIS)
• 89% of 75‑85 have CAC >0; 95% over 90
• Only ~24% of 75+ report clinical CAD despite 90% plaque
• Early autopsy shows fatty streaks in teens, yet 1% diagnosed CAD

Pulse Analysis

Imaging cohorts such as PESA and SCAPIS have reshaped our understanding of atherosclerosis, revealing that plaque formation begins decades before any clinical event. The high prevalence of multivascular disease in middle‑aged adults challenges the traditional reliance on symptom‑driven testing and supports the case for earlier, non‑invasive screening tools like coronary CT angiography or carotid ultrasound, especially for individuals with elevated LDL‑C or family history.

In the elderly, coronary artery calcium (CAC) scores serve as a powerful prognostic marker. Studies from MESA and ARIC demonstrate that nearly nine out of ten people aged 75‑85 possess measurable calcium, and the figure climbs to 95% past age 90. A CAC score above 100 Agatston units, present in roughly 62% of this cohort, signals high atherosclerotic risk and can guide intensified statin, bempedoic acid, or ezetimibe therapy, even when traditional risk calculators underestimate danger.

The stark disparity between subclinical plaque and diagnosed coronary artery disease—only about one‑quarter of seniors with plaque report clinical CAD—highlights a silent epidemic. Autopsy data showing fatty streaks in teenagers confirm that atherogenesis starts early, reinforcing the need for aggressive lipid‑lowering strategies in high‑risk patients. Clinicians should combine imaging insights with personalized pharmacotherapy to reduce the long‑term burden of cardiovascular mortality.