Heart attacks remain one of the leading causes of death around the world. Many people believe that if they do not have clear symptoms, such as chest pain or shortness of breath, then their heart must be healthy.
Others trust that a simple risk score calculated by their doctor will accurately tell them how likely they are to have a heart problem.
However, a new study from Mount Sinai in New York has found that current heart screening tools may be missing a large number of people who are actually at high risk of suffering a heart attack.
For years, doctors have relied on calculators called the ASCVD risk score or the newer PREVENT score. These tools use information such as a person’s age, sex, race, blood pressure, cholesterol levels, whether they smoke, and whether they have diabetes.
The calculator then estimates the person’s chance of having a heart attack or stroke within the next ten years. Based on the result, doctors decide whether to start cholesterol-lowering medication, suggest lifestyle changes, or order more tests.
People who fall into the “low” or “borderline” risk groups are usually reassured and sent home without further testing, especially if they do not have symptoms.
In the new study, however, researchers asked an important question: how many people who actually had a heart attack would have been considered low risk just days before it happened?
To find the answer, the team studied 474 patients under the age of 66 who had no known history of heart disease and who were treated for their first heart attack at Mount Sinai hospitals in New York City.
The study covered a period from January 2020 to July 2025. They collected detailed information about each patient, including medical history, blood pressure, cholesterol, and when their symptoms first appeared.
The researchers then calculated each patient’s ASCVD and PREVENT risk scores as if the assessment had been done two days before the heart attack occurred. The results were concerning. About 45 percent of these patients would not have been recommended for preventive treatment or extra testing using the commonly used ASCVD score.
Even worse, when the PREVENT score was applied, around 61 percent of patients would have been classified as low or borderline risk, meaning that they also would not have received further attention or treatment.
Another alarming finding was that many patients did not experience classic heart attack symptoms until very close to the actual event. Around 60 percent of them only developed symptoms like chest pain or shortness of breath within 48 hours of their heart attack.
This means that waiting for symptoms is often too late. By the time a person feels something is wrong, the heart attack may be just hours or days away.
This research shows that current tools, while useful for studying large populations, are not always reliable when it comes to predicting an individual person’s real risk. A person can appear “low risk” on paper while having dangerous build-up in their arteries growing silently.
This hidden build-up, known as plaque, can suddenly rupture and block blood flow to the heart, causing a heart attack without warning.
The lead researchers believe that it is time to rethink how heart disease is detected. Instead of only using risk scores and waiting for symptoms, they suggest a stronger focus on medical imaging that can actually see plaque inside the arteries.
This kind of imaging could reveal early signs of atherosclerosis, even in people who feel fine and have normal test results. Finding plaque earlier could allow doctors to start treatment before it turns into a life-threatening emergency.
In reviewing and analysing these findings, it becomes clear that although current risk calculators have helped guide care for many years, they are no longer enough on their own. They are based on averages taken from large groups and cannot fully capture the unique biology and lifestyle of each person.
This study highlights a major gap in our current approach to prevention. It suggests that many heart attacks might be preventable if doctors could identify hidden disease sooner. The results strongly support a shift toward more personalised screening, including imaging of the heart and arteries, to truly understand a person’s risk.
While more research is needed before guidelines change, this study is an important warning that “low risk” does not always mean “safe,” and relying only on numbers and symptoms may be putting lives in danger.
If you care about heart health, please read studies about how eating eggs can help reduce heart disease risk, and Vitamin K2 could help reduce heart disease risk.
For more information about heart health, please see recent studies about how to remove plaques that cause heart attacks, and results showing a new way to prevent heart attacks, strokes.
The study is published in JACC: Advances.
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