Heart attacks are often seen as sudden and unexpected events, but in reality, they usually develop silently over many years.
Fatty material called plaque slowly builds up inside the blood vessels that supply the heart. This process is known as atherosclerosis. Over time, these plaques can grow, harden, and eventually break open, causing a blood clot that blocks the flow of blood to the heart.
When this happens, a heart attack occurs. Doctors have long tried to prevent this by using simple screening tools and risk scores to identify people who are more likely to suffer a heart attack. Sadly, a new study shows that these tools are missing a large number of people who are actually in danger.
The study, led by researchers at Mount Sinai and published in the Journal of the American College of Cardiology: Advances, found that commonly used heart risk screening methods fail to identify almost half of people who are about to have a heart attack.
This is a serious warning sign that our current approach to prevention may not be enough. Many people who were later admitted to hospital for their first heart attack would not have been identified as high-risk just days before the event.
In everyday medical practice, doctors often use a calculator called the ASCVD risk score. This score estimates a person’s chance of having a heart attack or stroke within the next ten years. It looks at factors such as age, sex, race, blood pressure, cholesterol levels, smoking, and whether the person has diabetes.
A newer tool called PREVENT includes some additional information and is designed to give a broader picture of heart risk. These scores are used to decide who should take medications such as statins, who should have more tests, and who is considered “low risk.”
However, the Mount Sinai team discovered that these tools often underestimate real danger in individual patients. If the patients in the study had visited a doctor just two days before their heart attack, nearly half of them would have been told they were at low or borderline risk according to the ASCVD score.
Even more would have been labeled low risk using the PREVENT tool. This means they would likely have been sent home without extra testing or stronger prevention treatments, even though their arteries already contained dangerous plaques.
To understand this problem better, the researchers studied 474 people under the age of 66 who had their first heart attack. None of them were known to have heart disease beforehand. The researchers reviewed their personal information, including cholesterol levels, blood pressure, medical history, and symptoms.
Then, they calculated what each person’s risk score would have been two days before the heart attack occurred. They divided people into low, borderline, intermediate, and high-risk groups based on these results.
The findings were surprising and worrying. About 45 percent of the patients would not have qualified for preventive treatment under current ASCVD guidelines. When the PREVENT tool was applied, that number increased to more than 60 percent. This shows that many people with serious underlying disease are being missed by standard screening methods.
Another important finding was that symptoms often appear very late. Around 60 percent of people only noticed warning signs such as chest pain or shortness of breath less than two days before their heart attack.
By the time symptoms appear, the disease has often already reached a critical point. This means that waiting for symptoms before taking action may be far too late for effective prevention.
The researchers believe that instead of relying only on risk scores and symptoms, doctors should focus more on finding the plaque itself. Advanced heart imaging methods can actually see the buildup of atherosclerosis in the arteries before it causes a problem.
Detecting this “silent plaque” early could allow doctors to start treatment sooner, even in people who seem healthy based on current risk scores.
This study highlights a major weakness in today’s prevention model. Tools that work well for large populations do not always work well for individuals. Many heart attacks happen in people labeled as low or moderate risk, which means they do not receive the attention or treatment they might need.
If doctors can change their focus from predicting risk to directly finding early disease in the arteries, many lives could be saved.
In reviewing and analyzing the study, it becomes clear that this research is a powerful wake-up call. It does not suggest that current risk scores are useless, but it shows they are incomplete. They cannot see what is happening inside the arteries.
The study strongly supports the idea that a new approach is needed, one that combines traditional risk factors with modern imaging and earlier intervention. This could lead to more personalized care, better prevention strategies, and fewer heart attacks in the future.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
For more health information, please see recent studies about how to eat your way to cleaner arteries, and salt and heart health: does less really mean more?
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