Half of middle-aged people without risk factors for cardiovascular disease were found to have plaque in their arteries, in a study published in the Journal of the American College of Cardiology. The men and women in the study, nearly all in their 40s, each had a level of “bad” LDL cholesterol lower than 160, and none of the major risk factors of smoking, family history, high blood pressure or diabetes.

As plaque deposits in arteries grow larger, they can ultimately cause a heart attack, stroke, or dementia.

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Of the 1,779 healthy subjects, 30% had plaque in their arteries supplying blood to the legs, 23% in their carotid arteries supplying blood to the brain, and 17% in their abdominal aorta, while 11% had calcified plaque in their coronary arteries supplying oxygenated blood to the heart. Researchers tested the first three locations using ultrasound, and the last using a coronary artery calcium test. They found that 23% had plaque in one location, 21% had plaque in two or three locations, and 6% had plaque in four or more locations.

While this study evaluated subjects with no major risk factors, the researchers also noted their previous study showing that in a group of middle-aged men and women at “low” risk of cardiovascular disease, 60% had arterial plaque in at least one location, and 41% had plaque in two or more locations.

In an editorial comment on the study, the journal’s editors suggest that arterial imaging at an early stage could be used to guide treatment decisions that could help prevent cardiovascular disease.

The study, which is available free online, is “Normal LDL-cholesterol levels are associated with subclinical atherosclerosis in the absence of risk factors.” Atherosclerosis is the medical term for artery clogging. The editorial comment, also available free, is titled “Primary prevention of atherosclerosis: time to take a selfie?”