For years, cardiovascular prevention has followed a familiar script. Calculate a risk score. Ask about symptoms. Treat those who cross a defined threshold. Reassure everyone else.
New data from Mount Sinai challenges that model in an uncomfortable way. Nearly half of people who went on to have their first heart attack would have been labeled low or borderline risk just days before the event. Under current guidelines, many would not have qualified for further testing or preventive treatment.
This is not a failure of patient compliance or awareness. It is a structural blind spot in how risk is assessed.
Why Traditional Risk Tools Fall Short
The study reviewed 474 patients under the age of 66 who had no known coronary artery disease before their first heart attack. Researchers reconstructed how each patient would have been evaluated two days before the event using standard tools.
The atherosclerotic cardiovascular disease score, widely used in primary care and cardiology, classified 45 percent of these patients as low or borderline risk. A newer model called PREVENT, designed to improve prediction, performed even worse. It labeled 61 percent of these patients as low or borderline risk.
From a population standpoint, these tools work reasonably well. From an individual standpoint, they leave too much to chance.
Risk calculators rely on averages. They estimate probability across large groups, not the presence of disease in a specific person sitting in front of a clinician. A person can have active plaque formation and still look reassuring on paper.
Symptoms Arrive After the Window Closes
The second failure point is symptom based screening. In theory, chest pain or shortness of breath should trigger evaluation. In reality, most heart attacks do not announce themselves early.
In this study, 60 percent of patients experienced symptoms less than two days before their heart attack. That timeline offers little opportunity for meaningful prevention. By the time symptoms appear, plaque instability is often already present.
Relying on symptoms assumes that coronary disease behaves like an on off switch. It does not. Atherosclerosis develops silently for years before rupture.
You can refer the below link for more details:
https://www.jacc.org/doi/10.1016/j.jacadv.2025.102361
The Real Problem Is Silent Plaque
It is the rupture of the plaque that causes heart attacks and not the high cholesterol level or percentages of risks. Risk scores are likelihood approximations. They do not detect disease.
A large number of patients with heart attacks have a large plaque load even though they may be metabolically healthy. The lack of symptoms, normal cholesterol level, and the absence of diabetes do not ensure clean arteries.
This is where the present model of prevention fails. It puts great emphasis on risk estimation rather than disease detection.
What This Means for Patients and Clinicians
The results do not imply the rejection of risk scores. They emphasize the risk of their application as gatekeepers.
In patients, particularly when there is a history of metabolic changes, unexplainable fatigue, or a family history, patients might have placed a false sense of security in a low score. To clinicians, the paper justified the importance of looking beyond calculators to make decisions on those who should be further assessed.
Patients seeking the Best Cardiologist in Goodyear often ask whether their numbers look good. The more important question is whether disease is already present despite those numbers.
Cholesterol Treatment in Goodyear Needs Context, Not Just Targets
Statins and other lipid lowering therapies remain foundational in prevention. The issue is timing. If treatment is delayed because a patient does not cross a risk threshold, years of opportunity may be lost.
Cholesterol treatment in Goodyear has increasingly moved toward individualized decision making. That includes assessing lifetime risk, plaque burden when appropriate, and overall vascular health rather than relying solely on ten year projections.
Lowering cholesterol earlier in patients with silent atherosclerosis may prevent the very events risk calculators fail to predict.
A Call for Smarter Prevention
This study exposes a gap between how cardiovascular risk is measured and how heart attacks actually occur. Numerous people who had not been identified as high-risk have many heart attacks at the first instance.
To patients, this serves as a reminder to them not to think that low risk translates to no risk. It acts as a wake-up call to clinicians to reconsider prevention methods relying on averages too much.
Imaging, earlier intervention, and more nuanced cholesterol management already become part of routine care by the Best Cardiologists in Goodyear that adopt the practice.
Prevention works best when it identifies disease before symptoms begin. The science now makes it clear that waiting for scores or warning signs may be waiting too long.
