TOPLINE:

Current cardiac screening tools used to prevent myocardial infarction (MI) failed to identify nearly half of people who are at risk for MI, according to a new study. Those patients had low or borderline risk as per both standard and newer risk calculators for atherosclerotic cardiovascular disease (ASCVD). Most developed symptoms within 48 hours before the event, and many would not have been recommended statins or further testing if evaluated 2 days earlier.

METHODOLOGY:

• Researchers evaluated whether widely used or recently introduced tools could reliably identify patients at risk for a first MI.
• They retrospectively analyzed records of 465 patients aged 65 years or younger without known coronary artery disease who presented with a first type 1 MI at two large US centers between 2020 and 2025; 81% were men.
• For each patient, the 10-year ASCVD risk was calculated using the ASCVD Risk Estimator Plus. The PREVENT calculator was also applied, and both tools categorized risk as low (< 5%), borderline (5.0%-7.5%), intermediate (7.5%-20.0%), or high (> 20%).
• Researchers noted when symptoms began and simulated which patients, if assessed 48 hours before presentation, would have been recommended statin therapy or diagnostic imaging under current guidelines.

TAKEAWAY:

• The ASCVD Risk Estimator Plus classified 33% of patients as having low risk, 12% as having borderline risk, and 10% as having high risk; 10% met indications for statin therapy due to having low-density lipoprotein cholesterol levels ≥ 190 mg/dL or diabetes.
• The PREVENT calculator classified 45% of patients as having low risk, 16% as having borderline risk, and 3% as having high risk; 13% met indications for statin therapy.
• Overall, 60% of patients developed symptoms within 48 hours before MI; 53% had chest pain or dyspnea the same day, 7% within 2 days, and 23% within the prior week.
• If assessed under current guidelines 2 days before the event, clinicians would not have recommended statin therapy or imaging for 45% of patients based on their ASCVD Risk Estimator Plus scores and for 61% based on their PREVENT scores.

IN PRACTICE:

“To meaningfully reduce the burden of cardiovascular disease, prevention strategies must expand beyond a narrow focus on traditionally high-risk individuals and include those often classified as lower risk,” the researchers wrote.

“Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients,” corresponding author Amir Ahmadi, MD, clinical associate professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai Health System in New York City, said in a press release. “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,” Ahmadi said. 

SOURCE:

This study was led by Anna S. Mueller, MD, Department of Medicine at Mount Sinai West/Morningside in New York City. It was published online on November 21, 2025, in JACC: Advances.

LIMITATIONS:

The authors did not discuss any specific limitations of this study.

DISCLOSURES:

This study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.