Heart-attack risk calculators fail to flag almost half at risk, shows study

New findings show that almost half of future first-time heart-attack patients would not be flagged by existing tools, raising concerns over how heart disease risk is assessed and managed.

Think your heart-attack risk score is reassuring? A new study suggests it may not be telling the full story. Researchers have found that almost half of those who later suffer a first heart attack would not have been flagged by existing screening tools. Published in JACC: Advances, the study highlights significant blind spots in how heart-attack risk is currently assessed.

 

What did researchers analyse in the study?

 

Titled “Limitations of Risk- and Symptom-Based Screening in Predicting First Myocardial Infarction”, the study evaluated 474 individuals under the age of 66 with no prior known coronary artery disease. The analysis centred on two key points: whether the patients would have been eligible for preventive treatment based on their risk scores, and how early their symptoms appeared.

 

 

Researchers examined two screening tools: the atherosclerotic cardiovascular disease (ASCVD) risk score and Predicting Risk of Events Vascular Equations New Tool (PREVENT). They evaluated how each tool would have classified these patients just two days before their first heart attack. They found:

 

• Using the ASCVD tool, 45 per cent of the patients would not have qualified for preventive therapy or further testing, yet still went on to have a heart attack.
• With the PREVENT calculator, that number rose to 61 per cent.
• In addition, around 60 per cent of patients developed classic symptoms (such as chest pain or breathlessness) within two days of their cardiac event, meaning symptoms alone often came too late to trigger earlier intervention.

 

Why do these findings matter?

 

These findings highlight a major blind spot in cardiovascular prevention. Relying on standard risk scores and waiting for symptoms may not be enough to protect many individuals at risk. “Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients,” said Dr Amir Ahmadi, the study’s corresponding author and Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai.

 

"This study highlights that a lower risk score, along with not having classic heart attack symptoms like chest pain or shortness of breath, which is common, is no guarantee of safety on an individual level,” explained Dr Anna Mueller, the first author and internal medicine resident at the Icahn School of Medicine at Mount Sinai.

 

What changes do researchers recommend?

 

According to the authors, it is not enough to depend solely on risk calculations and symptoms. They advise using early imaging to look for atherosclerosis (plaque build-up in arteries), which can reveal silent heart disease before a heart attack occurs.

 

 “It may be time to fundamentally reconsider this model and move toward atherosclerosis imaging to identify the silent plaque – early atherosclerosis – before it has a chance to rupture,” said Dr Ahmadi.

 

The authors note that more research is needed to understand when imaging should be used, how cost-effective it is, and how it would work on a larger scale. However, adding imaging to routine preventive care could help fill the gaps left by current risk tools.

 

What are the implications for healthcare and patients?

 

For clinicians, public-health policymakers and individuals alike, this study prompts a re-evaluation of how heart-attack risk is assessed. Preventive cardiology may need to adopt more proactive screening using imaging in addition to traditional risk scoring.  

 

For patients, it shows that even a “low risk” label from current tools does not rule out hidden heart disease. This makes lifestyle changes, regular check-ups, and discussing imaging options with a cardiologist all the more important.