Modern methods for diagnosing cardiovascular diseases, relied upon by doctors worldwide, may fail to detect nearly half of patients on the verge of a heart attack. This conclusion was reached by researchers from the US and Canada, who analyzed medical data from hundreds of people who suffered their first heart attack before age 65. Their findings cast doubt on the effectiveness of standard screening tools and raise questions about the need to rethink approaches to cardiovascular prevention.
In the United States, the so-called ASCVD score—a special scale that factors in age, sex, blood pressure, cholesterol level, and race—is traditionally used to assess heart attack risk. If the final score exceeds a certain threshold, the patient undergoes further testing or is prescribed preventive treatment. However, the analysis showed that for nearly half of the patients who suffered a heart attack, this score was within the normal range just two days before the event.
Shortcomings of Standard Tests
The study included 465 people admitted to two major American medical centers with a first heart attack between January 2020 and July 2025. Doctors examined their histories, blood pressure readings, cholesterol levels, and other parameters typically used to assess risk. It turned out that according to the ASCVD scale, 45% of patients were classified as low- or borderline-risk, and according to the alternative PREVENT system, that figure reached 61%.
Cardiologist Amir Ahmadi from the Icahn School of Medicine at Mount Sinai emphasizes that mass risk assessment tools often fail to reflect the actual threat to an individual patient. Even if these patients had seen a doctor a few days before their heart attack, they would not have been prescribed additional tests or preventive measures, as their indicators would not have raised concern.
Why risks go unnoticed
In the United States, the ASCVD risk calculator is used for people aged 40 to 75 to estimate the likelihood of a heart attack or stroke in the next 10 years. If the risk exceeds 20%, patients are advised to take statins and other medications to reduce the chance of cardiovascular events. However, as research shows, many people with low or moderate scores still suffer heart attacks, often without any classic symptoms like chest pain or shortness of breath.
The authors of the study believe that existing risk assessment methods do not take individual characteristics into account and may overlook hidden signs of atherosclerosis—the buildup of fatty plaques in the arteries that lead to blockages. They suggest expanding the range of screenings to include tests for atherosclerotic changes even in those who are not classified as high-risk by standard scoring systems.
New approaches to prevention
Doctors note that most heart attacks occur in people whom standard tests classify as low or moderate risk. This means that the absence of alarming symptoms and low ASCVD scale scores do not guarantee safety. Moreover, alternative systems such as PREVENT are also not always able to identify patients who are in danger.
Although the study was conducted on a relatively small sample and is retrospective in nature, its results confirm the need to find more accurate and personalized diagnostic methods. Only this way can the threat be detected in time and the development of cardiovascular diseases prevented in people who outwardly appear completely healthy.
Looking to the future
Cardiologists urge not to rely solely on standard risk score calculations and the presence of symptoms. In their view, effective prevention of heart attacks requires the introduction of new screening methods that can detect hidden risks at an early stage. This is especially important for patients without obvious signs of disease, as it is among them that sudden heart attacks often occur.
The study was published in a respected medical journal and has already generated wide resonance within the professional community. Experts are confident that revising approaches to the diagnosis and prevention of cardiovascular diseases will help save thousands of lives every year.
In case you didn’t know, the Icahn School of Medicine at Mount Sinai in New York is regarded as one of the leading research centers in cardiology and internal medicine. The institution is home to renowned experts whose research regularly shapes global standards for diagnosing and treating cardiovascular diseases. The school actively implements innovative methods and participates in international clinical studies aimed at improving the quality of medical care.
