Over 62% of young adults referred for clinically indicated CCTA have coronary artery plaque detected by AI-enabled coronary plaque analysis, and plaque prevalence and burden increase with age.
The majority of young adults referred for clinically indicated CCTA had coronary atherosclerosis detected by AI-enabled coronary plaque analysis.
Coronary plaque prevalence increased significantly with age across the young adult population.
Among patients with coronary plaque, non-calcified plaque was universal while calcified and low-attenuation plaque were also highly prevalent.
Total plaque volume increased with age and was significantly higher in men than in women.
A substantial proportion of young adults in the cohort had hemodynamically significant coronary artery disease as indicated by CT-derived fractional flow reserve.
The study population was drawn from a large, contemporary, international, multicentre cohort using artificial intelligence-enabled coronary plaque analysis.
This research suggests that coronary artery disease — the buildup of plaque inside heart arteries — is surprisingly common in young adults. The study looked at over 1,600 patients between the ages of 18 and 49 from 29 hospitals worldwide who had a specialized heart scan (coronary CT angiography) ordered by their doctors. Using artificial intelligence to analyze the scans, researchers found that nearly two-thirds of these young adults already had detectable plaque in their coronary arteries. Even among the youngest group (ages 18-29), more than one in three had plaque present. The study also found important differences based on age and sex. Plaque became more common and more extensive as patients got older, which is expected, but the findings highlight that the disease process begins well before middle age. Men had significantly more plaque than women of the same age. Additionally, 44% of all patients had evidence of reduced blood flow to the heart based on a CT-derived measurement called fractional flow reserve, suggesting that a meaningful portion of these young adults may already have clinically significant heart disease. These findings matter because coronary artery disease is often thought of as a condition affecting older adults, but this research suggests the process is already well underway in many people by their 30s and 40s — and sometimes even earlier. The authors argue that this supports developing better strategies to identify young people at risk and intervene early, before heart attacks or other serious events occur. It is important to note that this study included only patients whose doctors had already ordered a cardiac scan for clinical reasons, so the results may not apply to the general population of young adults.
O'Gorman K, Metser G, Mullen S, Ng N, Leb J, Zhang Y, et al.. (2026). Prevalence and burden of coronary artery disease in young adults undergoing clinically indicated coronary CT angiography.. Open heart. https://doi.org/10.1136/openhrt-2026-004199