A new study conducted by specialists from Mount Sinai has revealed that widely used screening methods for cardiovascular diseases fail to identify nearly half of the people who are actually at real risk of a heart attack. According to the authors, these findings highlight significant shortcomings in current preventive approaches: existing guidelines may not cover patients who could benefit from earlier detection and timely treatment.

Limitations of Current Risk Assessment Methods

During the study, the team compared the accuracy of the traditional atherosclerotic cardiovascular disease (ASCVD) risk score with a new tool called PREVENT, which takes into account additional variables and is designed for a more comprehensive risk assessment, including symptom analysis.

The study’s lead author, Dr. Amir Ahmadi, notes: “Our research shows that risk assessment tools calculated at the population level often do not reflect the actual risk for many individual patients. If we had examined these people just two days before their heart attack, almost half of them would not have been recommended for further testing or preventive therapy according to current risk assessments and guidelines.” He adds that relying too heavily on standard risk calculators and symptom reporting may not be the most effective prevention strategy. In his view, it is time to rethink the current model and move toward visualizing atherosclerosis to detect ‘silent’ plaque—early stages of disease before complications develop.

How Risk Calculators Are Used

In everyday practice, doctors calculate the ASCVD risk score for adults aged 40 to 75 without established cardiovascular disease. This score estimates the likelihood of a heart attack or stroke within 10 years, considering age, sex, race, blood pressure, cholesterol levels, diabetes, and smoking status. The results from ASCVD or PREVENT calculators help guide decisions about prescribing preventive therapies, including statins.

Cardiologists also use these scores to determine treatment strategies. Patients with intermediate or high risk are usually prescribed cholesterol-lowering medications and, if necessary, additional diagnostic tests. People with low or borderline risk, especially in the absence of chest pain or shortness of breath, are often reassured and discharged without further evaluation.

However, the study showed that if patients who later suffered their first heart attack had been assessed two days before the event, almost half would have been classified as low or borderline risk by ASCVD, and more than half by PREVENT.

Study Design and Results

To evaluate the effectiveness of current tools, researchers conducted a retrospective analysis of 474 patients under 66 years old without established ischemic heart disease, who were hospitalized with their first heart attack at Mount Sinai Morningside or The Mount Sinai Hospital between January 2020 and July 2025. Demographic data, medical history, cholesterol levels, blood pressure readings, and the timing of symptoms such as chest pain or shortness of breath were collected. For each patient, the 10-year ASCVD risk was calculated, and researchers modeled how they would have been assessed two days before their heart attack. Patients were divided into four risk categories: low (less than 5%), borderline (5–7.5%), intermediate (7.5–20%), and high (over 20%).

The analysis showed that 45% of patients would not have received recommendations for preventive therapy or further testing according to ASCVD-based guidelines. With PREVENT, this proportion increased to 61%. Additionally, most patients (60%) noticed symptoms less than two days before their heart attack, indicating that symptoms often appear only in the later stages of the disease.

The Need to Rethink Preventive Approaches

Overall, the results reveal a serious gap in prevention: people who appear healthy by standard assessments may already have significant and asymptomatic atherosclerosis. Therefore, relying solely on symptoms and risk calculators can lead to detection that is too late for effective prevention.

The study’s first author, Dr. Anna Mueller, emphasizes: “Most heart attacks occur in patients with low or intermediate risk. Our research shows that a low risk score and the absence of classic heart attack symptoms, such as chest pain or shortness of breath, do not guarantee safety for an individual. Tools effective for assessing large populations do not work as well for personalized care. Doctors should shift their focus from detecting symptomatic heart disease to identifying plaque itself for earlier treatment, which could save lives.”

Future Research Directions

The authors note that further work is needed to improve risk assessment methods. Future studies should seek ways to enhance early diagnosis and prevention, including the use of cardiovascular system imaging.