Atherosclerosis builds quietly for decades, without symptoms. A risk score gives you a probability. A neck-and-groin ultrasound gives you a status.

Atherosclerosis is older than most people think

Cardiovascular disease is Switzerland’s leading cause of death. That part is well known. What’s less well known is when atherosclerosis, the disease behind most of it, actually starts.

The answer comes from a study most people would rather not read. The PDAY study examined the arteries of 2,876 people aged 15 to 34 in the United States who had died of external causes, mostly accidents. In the youngest group, 15 to 19 year olds, researchers found changes in the vessel wall in every major artery examined, and in more than half of right coronary arteries. The changes grew more frequent and more extensive with each year of age. The conclusion from Strong et al., 1999 was blunt: prevention needs to start in childhood or adolescence.

Atherosclerosis, in other words, isn’t a disease of old age. It’s a disease that runs across a lifetime. What shows up as an event at 60 already has decades behind it.

Key point

A heart attack at 58 usually isn’t a sudden event. It’s often the late end of a process that began decades earlier.

When the disease runs, and when it’s looked for

Schematic, from top to bottom over decades.

YOUTH First changes In 15- to 19-year-olds, an autopsy study already found changes in the artery wall (PDAY). DECADES The process runs quietly The changes build up, often without symptoms. FROM AGE 40 The score kicks in SCORE2 was developed for people aged 40 to 69.
Schematic illustration based on Strong et al. (1999) and the SCORE2 working group (2021), not patient data.

Why a risk score usually reassures younger people

Standard preventive care works from a ten-year risk estimate. A widely used model is SCORE2: age, smoking, blood pressure and cholesterol go in, a percentage for the next ten years comes out. It was developed for people aged 40 to 69 with no known vascular disease or diabetes. It’s a solid tool, and it’s built for populations.

It has one built-in quirk, though. Age feeds straight into the calculation. For someone who’s 40, the number usually comes out low, even if something has already formed in their arteries. The result reads: nothing to see, look again in a few years.

How often that misses the mark is something the Spanish PESA study measured directly. It scanned 4,184 symptom-free people aged 40 to 54 with ultrasound across several vascular territories, plus a coronary calcium CT. PESA found atherosclerosis in 63%, 71% of men and 48% of women. And among the people the classic score had placed in the low-risk group, 58% had a finding anyway.

Two questions that get confused for one another

The estimate on top, the finding below.

RISK PROFILE How likely is an event within 10 years? Estimated from age, blood pressure, lipids and smoking. Usually comes out low for young people. FINDING Is something there already, and how much? Ultrasound of the neck and groin, plaque seen directly. Applies at any age, no radiation. Both questions are fair. They just aren’t the same question.
Schematic overview, not a product claim.

Your neck and groin: where plaque shows up most often

If you’d rather look than estimate, the next question is where.

The answer surprises most people. Not the heart. PESA mapped where deposits turn up most often in symptom-free, middle-aged people, and the ranking is clear.

Vascular territory Share with a finding Method
Femoral arteries (groin) 44% Ultrasound
Carotid arteries (neck) 31% Ultrasound
Abdominal aorta 25% Ultrasound
Coronary arteries (calcium) 18% CT

The groin comes first, the neck follows. The coronary arteries sit at the bottom of the list, and there’s a technical reason for that: a calcium CT detects calcification, and calcification is a late stage. Soft, not-yet-calcified plaque simply doesn’t show up on it. A calcium score of zero doesn’t mean nothing is there.

Ultrasound has three practical advantages here. It picks up soft plaque too. It uses no radiation and no contrast agent, so there’s no age limit. And it can be repeated as often as makes medical sense.

Context

What gets measured is plaque area, not wall thickness. Area says more about risk, and it compares more reliably the next time round.

That this isn’t just plausible but actually useful shows up in a Swiss cohort. The ARCO study followed 2,842 people aged 40 to 65 for an average of almost six years. Adding carotid plaque area, measured by ultrasound, to the SCORE2 risk calculator reclassified far more people correctly: a net improvement of 24% for heart attack and stroke, and 39% for the broader category of vascular disease.

A score estimates a probability. An ultrasound shows a status. Someone with both is deciding from a different starting point.

What this means at Aeon

This is the logic behind the Arteries Plaque Check, an ultrasound of the neck and groin arteries.

The process is kept deliberately simple. About 20 minutes, no preparation, no fasting, no eligibility check beforehand. A doctor reviews the result, which then appears in your Aeon portal.

It looks at four things:

  • Whether plaque is present at all. The question a blood test can’t answer.
  • How much. Plaque area gets quantified, so a vague sense of risk becomes a number with a date attached.
  • Whether blood flow is affected. That can be assessed on ultrasound too, and a doctor puts it in context.
  • How it changes over time. With no radiation involved, you can scan again in a year and compare it with the last result.

And an honest caveat belongs here too: for assessing the coronary arteries specifically, CT remains the stronger method and the one better anchored in clinical guidelines. Ultrasound doesn’t replace it. It’s an early and low-effort layer, and a finding there can be a reason to talk to a doctor about further tests.

What changes

A result shifts the question from “what might happen someday” to “what’s there, and what do I do about it”.

The short version

Atherosclerosis runs across a lifetime. Early wall changes show up as early as adolescence.
A ten-year score is driven by age. It comes out low for younger people usually, even when a finding exists.
Your groin and neck lead the list. Deposits turn up there more often than calcium in the coronary arteries.
Ultrasound is repeatable. No radiation, no age limit, comparable over years.

The bottom line

“How high is my risk” isn’t the wrong question. It just isn’t the only one, and for younger people it’s the less informative one. The second question is: is something there already? You can answer it at any age, with no radiation, in twenty minutes. And it gives you a baseline you can actually compare against in a year or two.

That’s the difference between waiting and checking.

Book a scan 20 minutes, no radiation, doctor-reviewed result in your Aeon portal.

Frequently asked questions

What age is this worth doing at?

There’s no fixed age limit, and the ultrasound uses no radiation. The earlier you have a baseline, the more useful later comparisons become. Whether and when it’s worth doing for you personally is worth discussing with a doctor.

Does this replace a heart CT?

No. For assessing the coronary arteries themselves, CT is the stronger method and better anchored in clinical guidelines. Ultrasound sees earlier, uses no radiation, and suits tracking change over time. The two answer different questions.

My cholesterol is fine. Isn’t that enough?

Blood values describe risk factors, in other words influences. They don’t say anything about what has already formed in the vessel wall. In the PESA study, 58% of people with a low calculated risk had an ultrasound finding anyway. Good numbers are a good sign, not a guarantee.

How often can this be repeated?

As often as makes medical sense. Because there’s no radiation dose involved, there’s no technical ceiling on repeats. In practice the interval depends on the previous result and is set by a doctor.

And if plaque actually turns up?

A finding isn’t an emergency, it’s information. It changes the starting point: instead of talking about a possible future risk, you’re talking about a status that already exists. What follows from that gets decided with a doctor, based on the full picture of the finding, your blood values and your history.

Sources