Medical screening techniques could be failing to catch nearly half of those who experience a heart attack, according to new research. The study from the Icahn School of Medicine at Mount Sinai suggests that many of the millions of heart attacks that happen each year could be prevented with improved methods.
Nearly half (45%) of patients who suffered their first heart attack would have been classified as low or borderline risk just two days prior using standard ASCVD scores. The Researchers reviewed health records of 465 patients aged 65 or younger treated for first-time heart attacks between January 2020 and July 2025 at two US medical centers. They calculated retrospective ASCVD and PREVENT risk scores using actual patient data from days before events.
Shocking Results:
ASCVD scores: 45% categorized as low/borderline risk
PREVENT scores: 61% classified as low/borderline risk
“Population-based risk tools often fail individual patients,” says cardiologist Amir Ahmadi. “Nearly half would not have received preventive therapy under current guidelines.”
How ASCVD and PREVENT Scores Work (and Fail)
ASCVD Risk Calculator (used in US annual checkups for ages 40-75):
Predicts 10-year heart attack/stroke risk
Factors: age, sex, race, blood pressure, cholesterol, diabetes, smoking
High risk (≥20%) triggers statins/preventive measures
PREVENT Calculator (newer alternative):
Performed even worse, missing 61% of actual heart attack patients
Both tools rely on statistical averages, missing individuals with “silent” atherosclerosis — fatty plaques silently building in arteries.
The Silent Threat: Atherosclerosis Without Warning Signs
Internal medicine resident Anna Mueller explains, “Most heart attacks occur in low/intermediate risk groups. Low risk scores plus no classic symptoms like chest pain create a false sense of safety.”
Researchers urge direct atherosclerosis testing (plaque imaging) for better detection, rather than relying solely on risk calculators.
Q&A: What This Means for Heart Attack Prevention
Q: How many heart attack patients were missed by screening?
A: 45% by ASCVD, 61% by PREVENT — just days before their events.
Q: Who was studied?
A: 465 first-time heart attack patients ≤65 years old from 2020-2025.
Q: Why do risk scores fail individual patients?
A: They’re population averages; miss silent artery plaque buildup.
Q: What testing do researchers recommend?
A: Direct atherosclerosis imaging beyond statistical risk calculators.
Frequently Asked Questions (FAQ)
Q1: What is the ASCVD risk score?
A1: 10-year heart disease risk calculator used in US annual health checks for ages 40-75.
Q2: Why did PREVENT scores perform worse?
A2: Newer tool also relies on statistical predictions, missing individual plaque buildup.
Q3: Can asymptomatic people still have heart attacks?
A3: Yes — silent atherosclerosis causes most unexpected events in “low risk” groups.
Q4: What preventive steps should high-risk patients take?
A4: Statins, blood pressure control, cholesterol management regardless of risk scores.
Q5: How can individuals get better screening?
A5: Request coronary artery calcium scans or plaque imaging for direct assessment.
Call for Personalized Screening Revolution
“This study proves relying on risk scores and symptoms as prevention gatekeepers is not optimal,” concludes Dr. Ahmadi. The findings, published in Journal of the American College of Cardiology: Advances, demand a shift toward direct artery imaging for true risk assessment.
Heart disease remains the leading global killer. Better screening could prevent millions of heart attacks annually.