Current cardiac screening tools may overlook nearly half of individuals truly at risk of heart attacks, according to a recent study conducted by researchers at the Mount Sinai Health System. The findings, published on November 21, 2025, in the Journal of the American College of Cardiology: Advances, highlight significant concerns regarding existing patient care practices and the potential for missed opportunities in early heart attack detection.
The study assessed the effectiveness of the widely utilized atherosclerotic cardiovascular disease (ASCVD) risk score alongside a newer tool known as PREVENT. The PREVENT measure incorporates additional variables to provide a more comprehensive estimate of cardiovascular risk. The results reveal that relying solely on these screening tools may not adequately reflect the individual risk profiles of patients.
Amir Ahmadi, MD, a Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, stated, “Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients.” He emphasized that had many patients been evaluated just two days prior to their heart attacks, a significant portion would not have been recommended for further testing or preventive therapy based on current guidelines.
Healthcare providers typically calculate a patient’s ASCVD risk score during annual primary care visits for individuals between the ages of 40 and 75 without known heart disease. This score estimates a person’s ten-year risk of heart attack or stroke based on factors such as age, sex, race, blood pressure, cholesterol levels, diabetes, and smoking status. Physicians rely on these calculators to guide decisions about preventive treatments, including the initiation of statin therapy.
Patients with intermediate to high ASCVD scores usually receive cholesterol-lowering medications and may undergo further testing. Conversely, those deemed low or borderline risk, especially in the absence of symptoms like chest pain or shortness of breath, are often reassured and sent home without additional evaluation.
The study found that if individuals experiencing their first heart attack had been assessed two days earlier, nearly 45% would not have qualified for preventive therapy or diagnostic testing under the ASCVD guidelines. This figure increases to 61% when the PREVENT calculator is applied. Alarmingly, most patients (60%) did not exhibit symptoms such as chest pain or shortness of breath until less than 48 hours before their cardiac events, indicating that traditional symptom monitoring often fails to provide timely intervention opportunities.
To conduct this research, the team performed a retrospective analysis of data from 474 patients under the age of 66 who were treated for their first heart attack at Mount Sinai Morningside and The Mount Sinai Hospital in New York City from January 2020 to July 2025. The researchers collected demographic information, medical histories, cholesterol levels, blood pressure readings, and the onset timing of symptoms, which were defined as chest pain or shortness of breath.
The findings underscore a crucial gap in current prevention strategies. Patients who may appear healthy according to standard measures can still possess significant, undetected heart disease. “When we look at heart attacks and trace them backwards, most occur in patients classified within low or intermediate risk groups,” stated Anna Mueller, MD, the study’s first author and an internal medicine resident at the Icahn School of Medicine at Mount Sinai. “This study exposes a major flaw where tools effective for tracking large populations fall short when guiding individualized care.”
According to the researchers, the time has come to rethink the reliance on risk scores and symptoms as primary determinants for prevention. Instead, they advocate for a shift towards atherosclerosis imaging to identify silent plaque—early atherosclerosis—before it has the opportunity to rupture.
The authors suggest that further research is necessary to enhance early detection strategies and improve preventive measures, particularly through advanced cardiovascular imaging techniques. The findings of this study prompt a reevaluation of current practices in cardiac risk assessment and highlight the importance of personalized approaches in the management of heart health.
