New research indicates that existing medical screening methods may overlook nearly half of individuals who have a heart attack, hinting that with better techniques, many of these cases could potentially be avoided.
In the United States, assessing the risk of heart attacks generally relies on criteria like the atherosclerotic cardiovascular disease (ASCVD) score. This score evaluates various factors related to heart disease, guiding monitoring and treatment for patients who exceed set thresholds.
A study conducted by researchers in the US and Canada looked at the health records of 465 people aged 65 and younger who were treated for their first heart attack from January 2020 to July 2025 at two medical centers. The data encompassed factors such as medical history, blood pressure, and cholesterol levels.
Interestingly, the team’s findings revealed that just two days prior to their heart attacks, ASCVD scores would have placed 45% of these patients in the low or borderline risk categories. Another scoring system, named predicting risk of cardiovascular disease events (PREVENT), performed even worse—61% of participants were also classified as low or borderline risk.
“Our research shows that many population-based risk tools frequently fail to accurately gauge the individual risks of many patients,” notes a cardiologist from the Icahn School of Medicine at Mount Sinai.
“If we had assessed these patients just two days prior, nearly half wouldn’t have received recommendations for further testing or preventive care based on current risk scores and guidelines.”
In the US, the ASCVD score is typically calculated during annual check-ups for those aged 40 to 75, estimating the chance of a heart attack or stroke over the next decade based on aspects like blood pressure, cholesterol, and age.
Individuals deemed to be at intermediate or high risk—meaning a 20% or greater likelihood of an event occurring within ten years—are generally put on preventive measures, including medications like statins.
The researchers emphasize the need for improved risk assessment methods for asymptomatic individuals—those who currently wouldn’t be flagged by existing tools. They propose that maybe signs of atherosclerosis could be directly tested to better predict risks.
“When we examine heart attacks in hindsight, we observe that many occur in individuals categorized as low or intermediate risk,” points out an internal medicine resident at the Icahn School of Medicine.
This study brings to light that even a lower risk score, paired with a lack of classic symptoms like chest pain, doesn’t guarantee safety for individuals.
It’s important to recognize that the research analyzed the case histories of just a few hundred patients retrospectively, and the PREVENT scores have shown some effectiveness in larger populations.
Nevertheless, these scores seem to miss those without typical symptoms or risk indicators, according to the research team. They believe that adopting more personalized approaches could lead to earlier detection and prevention of heart disease.
“This study indicates that depending primarily on risk scores and visible symptoms for preventive measures may not be the best strategy,” asserts the cardiologist.
The findings have been published in the Journal of the American College of Cardiology: Advances.
