A new study from Mount Sinai has found that many people who suffer a heart attack would not have been flagged as high-risk just days before their event.
This means that commonly used tools for checking heart health are missing almost half of those who are actually in danger. The results were published in the Journal of the American College of Cardiology: Advances.
Doctors often use tools like the ASCVD risk score and a newer one called PREVENT to estimate someone’s risk of heart attack or stroke.
These scores are based on things like age, sex, race, blood pressure, cholesterol levels, smoking, and diabetes. They are used to decide who needs medicine or extra testing to prevent heart problems. But the new study shows that these tools may not work well for everyone.
Researchers looked at nearly 500 people under age 66 who had their first heart attack between 2020 and 2025. None of these people had known heart disease before. The researchers wanted to know what their risk scores would have looked like just two days before their heart attacks.
They found that 45% of these patients would not have been recommended for any preventive treatment based on the ASCVD tool. Using PREVENT, the number was even higher—61% would have been missed.
Many of these patients also had no warning signs. About 60% only started feeling symptoms less than two days before their heart attack. This means that relying on symptoms like chest pain or shortness of breath is often too late to stop the problem.
One of the lead researchers, Dr. Amir Ahmadi, said that current methods are not enough. “If we had seen these patients just two days earlier, many of them would have been told they were low risk,” he explained. “It’s time to move away from only using risk scores and symptoms to decide who gets help.”
Instead, the team suggests that doctors should start looking for the actual buildup of plaque in the arteries before symptoms appear. This plaque, made of fat and other substances, can quietly grow over time until it suddenly blocks blood flow and causes a heart attack.
Dr. Anna Mueller, the first author of the study, said that most heart attacks happen in people with low or intermediate risk scores.
“That means we’re missing too many people. These tools might work for studying large groups, but they don’t help enough when it comes to protecting individual patients.” She added that better tests are needed to catch this silent plaque early.
The findings suggest a major change is needed in how we prevent heart attacks. Instead of waiting for symptoms or relying only on risk scores, doctors may need to use heart scans or other tools to spot early signs of disease. This kind of early detection could lead to treatment that prevents heart attacks from happening in the first place.
The study makes it clear that more research is needed to develop better ways of spotting hidden heart disease. Tools like imaging may play a bigger role in the future. For now, the study is a strong reminder that feeling fine and having a low score doesn’t always mean you’re safe.
If you care about heart health, please read studies about how vitamin D influences cholesterol levels, and what we know about egg intake and heart disease.
For more health information, please see recent studies about best supplements for heart disease prevention, and wild blueberries can benefit your heart and brain.
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