Most first-time heart attack patients don't belong to high risk category, warns study

Causes of heart attack: Most heart attack risk scores rely on age, cholesterol, blood pressure, diabetes, smoking, and other population data. While useful at a population level, they miss the nuances of individual plaque buildup (Image: Canva)

You think you’re healthy, your cholesterol level is fine, and the doctor reassures you: low risk. Then, suddenly, a heart attack strikes. That’s the troubling reality highlighted by a new Mount Sinai study showing that nearly half of first-time heart attack patients were previously deemed low-risk.

Current risk calculators, including the popular ASCVD score and the newer PREVENT tool, are designed to predict who might suffer a cardiac event over the next decade. But researchers found that these population-based tools often miss the individuals who need help most.

At risk heart attack patients

“Our research shows that population-based risk tools often fail to reflect the true risk for many patients,” says Amir Ahmadi, MD, Clinical Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. “If we had seen these patients just two days before their heart attack, nearly half would NOT have been recommended for further testing or preventive therapy guided by current risk estimate scores and guidelines.”

The problem isn’t just underestimation — it’s timing. Most patients develop symptoms lesser than 48 hours before their heart attack. By then, prevention is far less effective. Experts argue that relying solely on risk scores and reported symptoms leaves many silently vulnerable, underscoring the need for a shift toward imaging-based detection of early atherosclerosis.

Risk scores often underestimate danger

ASCVD and PREVENT rely on age, cholesterol, blood pressure, diabetes, smoking, and other population data. While useful at a population level, they miss the nuances of individual plaque buildup. Nearly half of patients who suffered a first heart attack would have been classified as low or borderline risk.

Symptoms appear too late

Most heart-attack sufferers only notice warning signs like chest pain or breathlessness less than two days prior. By then, it’s often too late for conventional preventive measures.

The study examined 474 patients: Mount Sinai investigators reviewed patients under 66 with no prior coronary disease. Researchers simulated evaluations two days before the heart attacks, revealing alarming gaps: 45 percent of patients would have been overlooked by ASCVD, rising to 61 percent with PREVENT.

Early detection could save lives

“When we look at heart attacks and trace them backwards, most occur in patients in the low or intermediate risk groups,” says Anna Mueller, MD, first author and internal medicine resident at Icahn School of Medicine. Detecting silent plaque directly, rather than waiting for symptoms or relying on risk scores, could transform prevention.

Current guidelines need a rethink

Experts are calling for a move from symptom-based strategies toward imaging and more precise detection. Earlier intervention could allow doctors to prescribe targeted therapies before the plaque ruptures, potentially saving countless lives.

With nearly half of first-time heart-attack patients flying under the radar of current risk tools, it’s clear that low-risk doesn’t mean no risk. Mount Sinai’s findings point to a pressing need to modernise prevention, focusing on early detection and smarter, more personalised care.

FAQs on Heart Attack

1. What are the common symptoms of a heart attack?

Heart attack symptoms often include chest pain, breathlessness, and discomfort in the upper body. These signs usually appear less than 48 hours before the attack.

2. How reliable are current heart attack risk calculators?

Current risk calculators like ASCVD and PREVENT often underestimate an individual's risk, missing nearly half of potential first-time heart attack patients deemed low-risk.

3. Why do current risk calculators often miss high-risk individuals?

These tools rely on population data such as age, cholesterol, and blood pressure but fail to account for individual plaque buildup nuances, leading to misclassification.

4. Can early detection of heart disease prevent heart attacks?

Yes, imaging-based detection of atherosclerosis can identify silent plaque buildup early, allowing for timely intervention and potentially preventing heart attacks.

5. Why is there a need to shift from symptom-based to imaging-based detection?

Symptom-based strategies often detect heart disease too late, within 48 hours before a heart attack. Imaging can identify risks earlier, enabling preventive measures and saving lives.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.