Nearly Half Of Heart Attack Risks Go Undetected By Current Screening Tools: Study

In a stark warning for global cardiovascular care, a new study led by researchers at Mount Sinai, New York, has revealed that current heart attack screening tools fail to identify nearly 45% of people who are genuinely at risk.

The findings, published in JACC: Advances, raise serious concerns about over-reliance on traditional risk-scoring methods that may leave a large proportion of patients dangerously unprotected.

The study exposes a major blind spot in existing guidelines, showing that symptoms and standard risk calculators often fail to capture the silent build-up of plaque—the underlying process that leads to heart attacks.

“Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients,” said Dr. Amir Ahmadi, Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai and the study’s lead author.

According to his team’s analysis, if many of the heart attack patients had been screened just two days before their event, nearly half would not have been recommended for further testing or preventive treatment.

The study evaluated the accuracy of two widely used cardiac risk prediction tools that guide preventive therapy decisions for millions of people worldwide. The first is the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score, a long-established tool used in clinical practice to estimate a person’s likelihood of developing heart disease over the coming years. The second is PREVENT, a newer calculator that incorporates additional variables and aims to offer a more refined and comprehensive assessment of cardiovascular risk.

Researchers analysed both tools using data from 474 patients under the age of 66 who had no previously diagnosed coronary artery disease but went on to suffer their first heart attack. The purpose was to understand whether these risk calculators would have identified these individuals as candidates for preventive therapy if they had been assessed just two days before their cardiac event.

The findings were striking. Nearly half of the patients would have been classified as low or borderline risk by the ASCVD score and therefore not recommended for further diagnostic testing or preventive medication. The PREVENT tool fared even worse — more than half the patients would have been labelled low risk under its criteria.

In total, 45 per cent of patients would not have received preventive intervention based on ASCVD guidelines, and this proportion rose to 61 per cent when applying PREVENT. These results suggest that despite being standard clinical tools, both calculators miss a significant share of individuals silently progressing toward a cardiac event.

The researchers also noted that 60 per cent of patients developed symptoms such as chest pain or breathlessness less than 48 hours before their heart attack. This indicates that symptom-based screening is often too late to alter the course of the disease, as the underlying plaque builds up quietly over months or years.

Experts involved in the study stressed that the findings reveal a critical gap in current preventive strategies. They argue that early detection should move beyond reliance on risk scores and symptoms alone. Instead, the focus must shift toward direct atherosclerosis imaging—techniques capable of visualising “silent plaque” long before it ruptures and triggers a heart attack.

India, already grappling with an escalating burden of cardiovascular disease—with heart attacks occurring nearly a decade earlier than in Western populations—may find these insights particularly urgent.

As young adults increasingly fall victim to sudden cardiac events, experts warn that relying solely on symptoms or basic screening tools is inadequate. Many Indians with normal cholesterol or borderline risk scores may still harbour significant, undetected plaque.

The study makes it clear: more than half of future heart attacks may come from people currently considered “safe” under existing guidelines. Without a shift toward early detection of plaque, many preventable cardiac events will continue to slip through the cracks.