New research published in JACC: Advances has shown that about half of heart attacks occur in people who are considered “low-risk” by standard heart attack risk calculators.
The study retrospectively analyzed 465 patients who did not have known coronary artery disease and who were hospitalized due to a heart attack from 2020 to 2025. Data was collected about these patients, including demographic information, medical history, cholesterol, blood pressure, and the onset of symptoms. Using this information, their risk scores for having a heart attack were retrospectively calculated using two common measures, the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator and the PREVENT calculator. Both calculators are commonly used to give doctors and patients a picture of a patient’s risk of having a heart attack. The objective of the study was to retrospectively determine whether patients who had a heart attack would have been identified as high-risk using these common screening methods.
The results showed that only about half of the patients would have been identified as having high heart attack risk if they had been evaluated two days before having a heart attack. These patients would not have been recommended for preventive therapy or diagnostic imaging, potentially worsening their outcomes.
The authors noted that these results clearly show the limitations of popular risk calculators, which are currently failing to identify many patients who are at high risk. For this reason, approaches to identifying high-risk individuals may need to be fundamentally reconsidered. A more accurate approach may include imaging of plaque to identify early atherosclerosis. Many patients who are at risk of a heart attack have few symptoms or do not show classic symptoms like chest pain, and atherosclerosis is sometimes called a “silent killer” because it can build up for years with few symptoms. Imaging-based screening may be a more effective method than current risk calculators for identifying patients who are at risk or in need of preventive therapy.
Sources: JACC: Advances, Science Daily
