New Study Reveals: Nearly Half of At-Risk Individuals Missed by Current Heart Attack Screening Tools

A recent multi-center study led by Mount Sinai researchers in the United States finds that nearly 45% of individuals at risk for heart attacks are overlooked by the most widely used screening tools, according to a report published in JACC: Advances in late November 2025. The research exposes major shortcomings in current clinical practices for identifying people in danger before they experience a heart attack, prompting urgent discussions on how to improve prevention.​

Key Findings: The Gaps in Heart Attack Screening

Researchers analyzed data from 474 patients under age 66 with no prior diagnosis of coronary artery disease. If evaluated two days before their first heart attack, almost half of these patients would not have been flagged for preventive therapy or further testing by current guidelines using the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. When using a newer, supposedly more comprehensive tool called PREVENT, the number rose to 61%.​

Notably, 60% of patients developed symptoms like chest pain or shortness of breath less than two days before their heart attack, highlighting that clinical symptoms often emerge too late for effective intervention.​

Expert Commentary: Calls for Change

Dr. Amir Ahmadi, Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai and corresponding author, stresses: “Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients. If we had seen these patients just two days before their heart attack, nearly half would NOT have been recommended for further testing or preventive therapy guided by current risk estimate scores and guidelines”.​

According to Dr. Ahmadi, shifting prevention strategies to focus more on atherosclerosis imaging could help identify so-called “silent plaques”—the hidden build-up within arteries that often leads to heart attacks—before these can rupture. This approach could supplement or eventually replace reliance on risk scores and symptom-based screening as primary tools.​

Context: Understanding Risk Scores and Their Limitations

The ASCVD risk calculator and its newer counterpart PREVENT incorporate factors such as age, cholesterol, blood pressure, diabetes status, and smoking, among others. While these tools have been widely used for decades and aid clinicians in guiding preventive therapy, growing evidence suggests they may underestimate risk in certain groups, especially younger populations and women, and across different geographic or demographic groups.​

Multiple international studies have found that no single risk score perfectly predicts individual risk, as population-based equations may not capture unique genetic factors, lifestyle differences, or newer markers of early disease. Some risk calculators also overestimate or underestimate risk based on age, gender, or ethnicity.​

Broader Implications for Public Health

The findings serve as a wakeup call to public health policymakers and practicing clinicians. Incomplete identification of high-risk individuals means missed opportunities for targeted interventions, such as lifestyle modifications or medications that could prevent a first heart attack. With cardiovascular disease remaining a leading cause of death globally, even modest improvements in screening precision could yield significant reductions in mortality.​

The study also renews the push for integrating atherosclerosis imaging, such as coronary calcium scoring or advanced non-invasive scans, into routine care for those at uncertain risk levels. While these tests come with cost and accessibility challenges, their ability to detect silent disease could dramatically shift prevention strategies.

Limitations, Counterarguments, and The Road Ahead

Despite the urgent tone, experts caution that widespread use of high-cost imaging is not currently feasible for all populations and that risk scores remain a valuable, evidence-based foundation—especially in resource-constrained settings. Individualized interpretation and periodic recalibration of these tools, taking into account local data and patient diversity, are strongly advised.​

Dr. Rebecca James, a preventive cardiologist at Cleveland Clinic not involved in the study, commented: “Risk calculators, while imperfect, are better than subjective judgment alone. The goal should be to enhance these tools with new research, not to discard them entirely. Imaging is promising, but access must be equitable and cost-effective to truly benefit public health.”

Practical Takeaways for Readers

• Heart attack risk calculators are useful but have limitations; some people with hidden plaque may be missed despite normal scores.

• Symptoms like chest pain often appear only shortly before an event; proactive communication with healthcare providers about family history, lifestyle, and advanced screening is critical.

• Healthy lifestyle choices—regular exercise, a balanced diet, not smoking, and managing chronic conditions—remain the cornerstone of prevention for everyone, regardless of risk score.

Medical Disclaimer

This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

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