DETECTion of the Prevalence of Silent Atherosclerosis Across Adult Life - Phase I of REACT

Overview

Atherosclerosis is preventable, yet it continues to significantly contribute to global morbidity and mortality. Atherosclerosis may occur early in life and may present in all vascular territories. The DETECT study's main aim is to determine the prevalence of asymptomatic atherosclerosis (silent) in an adult population of a wide age range of European ancestry through vascular ultrasound (VUS) of peripheral arteries (carotid and femoral territories), as well as establishing the relationship between atherosclerosis in peripheral arteries, coronary arteries, and other vascular territories assessed by computed tomography angiography (CTA). The DETECT study also aims to identify risk factors for development of subclinical atherosclerosis that can hopefully improve the detection of the risk for development of atherosclerotic cardiovascular disease (ASCVD) with far higher precision than currently. In future research, the findings in this descriptive study may eventually be used as part of an age-adapted imaging-based screening for subclinical atherosclerosis. The investigators hypothesize that a precision medicine-based approach to identify candidates likely to benefit from primary prevention against atherosclerosis, may improve medical decision making, by combining traditional risk factors, including lifestyle and psychological factors, phenotypic findings and findings on vascular imaging, and patterns of circulating biomarkers to identify risk of atherosclerosis especially in young individuals and at earlier disease stages (the ultimate population target of REACT project, phase II), maximizing the potential for prevention long before overt disease occurs. An essential aspect of this approach is to pinpoint the specific risk factors in each individual that primarily drive atherosclerosis throughout their life and could serve as therapeutic targets. Thus, the overall purpose of this study is to establish the necessary knowledge, including extensive characterisation of atherosclerosis across life and thus add to the rational foundation for future development of a far more efficient and precise prophylaxis against ASCVD as compared with the presently applied methods.

REACT (DETECT, Phase I) is a multicentre Danish-Spanish prospective cohort study. Adults 18 to 70 years of age without known atherosclerotic cardiovascular disease (ASCVD) were enrolled in five prespecified age strata (18-29, 30-39, 40-49, 50-59, 60-70 years) with an approximately equal number of women and men in each stratum. Enrollment was designed a priori to include approximately 2,000 participants in each of the 18-29 and 60-70 year strata and approximately 4,000 in each of the 30-39, 40-49 and 50-59 year strata, across four sites in Denmark and four sites in Spain. All participants underwent multimodal imaging for silent atherosclerosis: three-dimensional vascular ultrasound of the carotid and femoral arteries, coronary computed tomography angiography (CCTA), and non-contrast computed tomography for coronary artery calcium scoring (CACS), together with extensive clinical, lifestyle, psychological and biological (blood, urine, DNA) phenotyping. Participants were enrolled from November 2024 through June 2026.