Current cardiac screening tools, designed to identify individuals at risk of heart attacks, are failing to detect nearly half of those who are actually at risk. This alarming finding emerges from a study conducted by researchers at the Mount Sinai Health System, published on November 21 in the Journal of the American College of Cardiology: Advances. The study highlights significant shortcomings in existing patient care practices, suggesting that adherence to current screening guidelines often leads to missed opportunities for early detection and prevention of heart attacks.
The research focused on two key assessment tools: the widely used atherosclerotic cardiovascular disease (ASCVD) risk score and a newer measure known as the PREVENT calculator. The latter incorporates additional variables to deliver a more comprehensive estimate of cardiovascular risk, alongside symptomatic assessments. According to Amir Ahmadi, MD, Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai and the study’s corresponding author, “Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients.”
Dr. Ahmadi emphasized the implications of these findings, stating that had physicians seen patients just two days before their heart attacks, nearly half would not have qualified for further testing or preventive therapy based on current risk assessment scores. This indicates a pressing need to reconsider the existing model, advocating for a shift towards atherosclerosis imaging to identify silent plaque formation indicative of early-stage heart disease.
Currently, during annual primary care visits, doctors typically calculate a patient’s ASCVD risk score for individuals aged 40 to 75 who have no known heart disease. This score estimates the 10-year risk of experiencing a heart attack or stroke, factoring in age, sex, race, blood pressure, cholesterol levels, diabetes, and smoking habits. Physicians employ these risk calculators to guide treatment decisions, including the initiation of statin therapy.
Patients identified with intermediate or high risk according to these calculators are often prescribed cholesterol-lowering medications and may undergo additional diagnostic testing. Conversely, those classified as low or borderline risk, particularly in the absence of symptoms such as chest pain or shortness of breath, frequently receive reassurance and are sent home without further evaluation.
The study conducted a retrospective analysis involving data from 474 patients under the age of 66, all of whom were treated for their first heart attack at Mount Sinai Morningside and The Mount Sinai Hospital in New York City between January 2020 and July 2025. Researchers gathered detailed personal information, including patient demographics, medical history, cholesterol levels, blood pressure, and the onset of symptoms, defined as chest pain or shortness of breath.
Each patient’s 10-year ASCVD risk was calculated, alongside a simulated assessment as if the patient had been evaluated two days prior to their cardiac event. The results categorised patients into four risk groups: low (under 5 percent), borderline (5-7.5 percent), intermediate (7.5-20 percent), and high (more than 20 percent).
The findings were striking. Overall, 45 percent of patients would not have been recommended for preventive therapy or diagnostic testing under current ASCVD guidelines. This figure rose to 61 percent when utilizing the PREVENT calculator. Notably, 60 percent of patients did not show symptoms until less than two days before their heart attack, illustrating the critical gap between symptom presentation and effective preventive measures.
Dr. Anna Mueller, an internal medicine resident at the Icahn School of Medicine and the study’s first author, remarked, “Our study exposes a major flaw where tools effective for tracking large populations fall short when guiding individualized care.” She stressed the need for a paradigm shift, advocating for a focus on detecting atherosclerosis rather than only symptomatic heart disease.
The researchers concluded that further studies are essential to enhance early detection strategies and improve prevention methods, including the potential integration of cardiovascular imaging. Such advancements could significantly impact patient outcomes and reduce the incidence of heart attacks in populations deemed low or intermediate risk by current standards.
