New Study Shows Current Heart Attack Screening Tools Miss Nearly Half of At-Risk Individuals
A new study led by researchers at Mount Sinai reveals a serious gap in how we identify people at risk of a first heart attack. Even though modern medicine offers several screening tools designed to estimate cardiovascular danger, this research shows that these tools still fail to recognize almost half of the individuals who will soon experience a heart attack. The findings challenge long-standing prevention strategies and raise important questions about how we evaluate heart health today.
The study, published in JACC: Advances, examined how well two widely used risk calculators—the ASCVD risk score and the newer PREVENT model—would have identified people at risk if they had been assessed just two days before their heart attack. The results suggest that relying mostly on risk scores and symptoms may be an outdated approach that leaves too many people unprotected.
What the Researchers Did
To dig into the problem, researchers performed a retrospective analysis using medical data from 474 patients under the age of 66. All of them were treated for their first heart attack at Mount Sinai Morningside or The Mount Sinai Hospital in New York City between January 2020 and July 2025. Importantly, none of these patients had any known coronary artery disease before their event—meaning they represented the typical group that preventive screening is meant to protect.
The investigators collected a broad range of information, including demographics, cholesterol levels, blood pressure, medical history, and details about when symptoms such as chest pain and shortness of breath began.
Then they simulated a scenario as if these individuals had been evaluated 48 hours before their cardiac event. Using that imagined checkup, the team calculated each patient’s 10-year cardiovascular risk and placed them into four categories:
- Low risk: under 5%
- Borderline risk: 5–7.5%
- Intermediate risk: 7.5–20%
- High risk: more than 20%
These categories guide real-world decisions about whether doctors should prescribe statin therapy, recommend lifestyle changes, or order further testing.
Key Findings That Raise Red Flags
The results were striking. Using the long-trusted ASCVD risk calculator, 45% of the patients would have been labeled low or borderline risk—meaning no statins and no further testing—even though they suffered a heart attack just two days later.
The newer PREVENT calculator performed even worse. It classified 61% of the patients as low or borderline risk, making it even less helpful at flagging those who would soon experience a major cardiac event.
Both tools therefore miss a significant portion of at-risk individuals. The numbers paint a clear picture: current risk calculators, even the updated ones, are not capturing the full story of cardiovascular vulnerability.
Another major insight concerns symptoms. About 60% of the patients did not experience any warning signs until less than two days before their heart attack. These late-appearing symptoms make it incredibly challenging for both patients and doctors to intervene in time. Mild or absent symptoms can lull people into a false sense of security while silent plaque continues to develop.
Together, these findings suggest that traditional methods of screening cannot reliably detect hidden heart disease, especially in people who appear relatively healthy on paper.
What This Means for Current Medical Practice
Doctors typically calculate ASCVD risk during routine primary-care visits, especially for adults aged 40 to 75 without known heart disease. The risk score guides decisions about preventive therapy, usually focusing on cholesterol management and lifestyle adjustments. Cardiologists also depend on these calculators to decide whether someone needs additional testing.
But this study shows that when applied to individuals—not broad populations—these tools may fall short. Many patients who will soon suffer a heart attack might not meet the thresholds for preventive treatment. In other words, someone can have a technically “low” score while still harboring dangerous atherosclerotic plaque.
This creates a mismatch between clinical guidelines and real-world outcomes. Although the risk calculators work well on a population scale, their usefulness is limited when the goal is to predict heart attacks for individual patients.
Why Silent Atherosclerosis Matters
The research highlights a crucial concept: atherosclerosis begins quietly, and plaque can grow for years without causing obvious symptoms. Heart attacks often occur when a plaque ruptures suddenly, blocking blood flow.
Because plaque buildup is the true underlying cause—not just cholesterol readings or demographic factors—the study argues that screening should shift from estimating risk to identifying early plaque itself.
Tools like coronary artery calcium scoring and advanced cardiac imaging can detect plaque before it becomes dangerous. While these methods aren’t used routinely for everyone today, the new findings suggest that broader use of imaging may help catch early disease that risk scores overlook.
The Case for Changing How We Screen
The researchers behind the study believe it may be time to rethink the entire prevention model. Instead of relying primarily on symptoms and risk categories, physicians could more directly assess the presence of actual disease. This approach would mirror how other fields of medicine screen for early problems—such as mammograms for breast cancer or colonoscopies for colon cancer.
If plaque can be detected earlier, more patients could receive preventive therapy before a dangerous event occurs. That shift could save lives and reduce the personal and financial burden of heart disease.
However, the transition to widespread imaging-based screening raises questions about cost, accessibility, radiation exposure, and how to use imaging results wisely. More research is needed to refine who should be screened, how often, and what the most effective tools are.
Additional Context About Heart Disease Screening
Heart disease remains the leading cause of death worldwide. Because of that, medical professionals heavily emphasize prevention. Risk calculators like ASCVD are popular because they are simple, fast, and based on large datasets. They combine factors such as:
- Age
- Sex
- Race
- Blood pressure
- Cholesterol levels
- Diabetes status
- Smoking history
These tools provide helpful estimates, especially across large populations. But individual variation is enormous. Some people have genetically driven plaque buildup despite healthy-appearing numbers. Others may have borderline cholesterol but rapidly progressing disease.
Adding imaging into routine screening could help bridge that gap between risk factors and actual disease detection.
What Patients Should Know
For everyday individuals, this study reinforces a few important points:
- A low risk score does not always mean low real-world risk.
- Symptoms like chest pain often appear too late to prevent a heart attack.
- Asking a doctor about more detailed screening—especially if you have a family history of heart disease—could be worthwhile.
- Lifestyle choices such as diet, exercise, avoiding smoking, and managing blood pressure remain powerful tools for prevention, but they do not guarantee safety.
Understanding personal risk involves combining traditional metrics with awareness of newer screening possibilities.
The Bottom Line
The Mount Sinai study shows that current heart attack screening tools may be missing nearly half of the people who are actually at risk. That’s a major wake-up call for both the medical community and the public. The findings strongly suggest that a more accurate, imaging-based approach could improve early detection and prevention. As research continues, this could lead to a significant shift in how doctors evaluate cardiovascular health.
Research Reference:
Limitations of Risk- and Symptom-Based Screening in Predicting First Myocardial Infarction – JACC: Advances
