A recent study led by researchers at Mount Sinai has revealed a critical issue with the current cardiac screening methods used to prevent heart attacks. Published in JACC: Advances, the research found that nearly 45% of patients at actual risk of heart attacks would be missed using the widely adopted atherosclerotic cardiovascular disease (ASCVD) risk score.
Even a newer, more comprehensive tool called PREVENT failed to identify more than half of these high-risk patients. This suggests a significant gap in patient care, where many individuals at risk of first-time heart attacks are not flagged in time for preventive therapy.
Cardiac screening plays a crucial role in preventing heart disease and saving lives by detecting early warning signs before symptoms appear. Many heart conditions, such as high blood pressure, high cholesterol, and coronary artery disease, develop silently and often only become noticeable once the disease has progressed. Regular screening can identify these risks early, allowing timely intervention through lifestyle changes, medications, or procedures that significantly reduce the risk of heart attack, stroke, or heart failure.
The study analyzed data from 474 patients under the age of 66 who suffered a first heart attack between 2020 and 2025. Researchers retrospectively applied the atherosclerotic cardiovascular disease and PREVENT risk assessments as if the patients were evaluated just two days before their cardiac events. They found that 45% would not have received preventive treatment recommendations based on atherosclerotic cardiovascular disease guidelines, increasing to 61% with PREVENT. Additionally, most patients (60%) developed classic symptoms like chest pain and shortness of breath only in the final two days before their attack, making symptom-based prevention unreliable.
Lead author Dr. Amir Ahmadi highlighted that population-based risk tools work at a broad level but often fail to accurately reflect individual risk. The study recommends shifting the focus from symptom and risk score screening to early detection of atherosclerotic plaque—the silent buildup in arteries that eventually causes heart attacks. Advanced imaging techniques to identify these plaques before they rupture might dramatically improve prevention.
The findings underscore the urgent need for more precise, personalized cardiovascular risk assessment methods. Enhanced screening could save lives by enabling timely preventive interventions.
REFERENCE: Mueller, A, Leipsic, J, Tomey, M. et al. Limitations of Risk- and Symptom-Based Screening in Predicting First Myocardial Infarction. JACC Adv. 2025 Dec, 4 (12_Part_2) .https://doi.org/10.1016/j.jacadv.2025.102361
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