If you were asked to picture someone headed for their first heart attack, you would probably imagine someone with high cholesterol, a smoker, obese, and with elevated blood lipids—the classic profile. However, people who fit this description make up only a small share of those who go on to have heart attacks.
Researchers at Mount Sinai found that many heart attacks strike people who, by current medical guidelines, are considered low risk.
“What we wanted to understand was this—if we took the patients who presented with a heart attack, and imagined seeing them two days earlier, how well would these tools have performed?” Dr. Anna Mueller, the study’s first author, told The Epoch Times.
Their study, published in JACC: Advances, found that 45 percent to 61 percent of heart attack patients would not have qualified for preventive treatment just two days before their attack.
“They would have been reassured and sent home without medication or further testing,” Mueller said.
Most Heart Attack Patients Were ‘Low Risk’
The researchers analyzed data from 465 patients under age 66 who had no known coronary artery disease but experienced their first heart attack at Mount Sinai hospitals in New York City between January 2020 and July 2025.
The team collected comprehensive health information, including demographics, medical history, cholesterol levels, blood pressure, whether they smoked, and symptoms at the time, including chest pain or shortness of breath. They then calculated each patient’s risk score two days prior to their heart attack.
Patients were sorted into four risk categories—low, borderline, intermediate, and high, respectively—with most heart attacks occurring in the low and borderline risk groups.
Additionally, 60 percent of patients developed telltale symptoms of a heart attack—such as chest pain or shortness of breath—only less than two days before their heart attack, which is far too late for preventive intervention.
The guidelines researchers used to assess patients’ risk of a heart attack were the atherosclerotic cardiovascular disease (ASCVD) risk score and PREVENT, both of which are widely used clinical guidelines. ASCVD missed 45 percent of the patients at risk, while PREVENT missed 61 percent.
Why Current Tools Often Fail
“Cardiovascular disease has been the No. 1 killer for decades, yet our ability to detect people early has not meaningfully improved,” Mueller said. “This urgently needs to change.”
Currently, doctors calculate a patient’s ASCVD risk score during annual checkups, mainly for people aged 40 to 75 without known heart disease. This score estimates the 10-year risk of a heart attack or stroke. Using the scores, physicians determine whether to start preventive treatments such as cholesterol-lowering medications.
However, the study indicated that a lower risk score, combined with the absence of classic symptoms such as chest pain or shortness of breath, does not guarantee safety at the individual level.
Mueller and her colleagues argued that doctors should shift focus from detecting symptomatic heart disease to detecting arterial plaque for earlier treatment—an approach that they believe could save lives.
Heart attacks are driven by plaque. When it breaks off from a blood vessel and becomes stuck, it blocks the blood vessels inside the heart from receiving oxygen, leading to a heart attack.
The problem is that it is hard to predict when the plaque will rupture and if it would cause a problem, Dr. Peter Kowey, a cardiologist at the Lankenau Institute for Medical Research and professor of medicine at Sidney Kimmel Medical College at Thomas Jefferson University, and not involved in the study, told The Epoch Times.
Current screening tools do not address plaque screening, which requires imaging and is not routinely used in assessments.
“There are so many variables that go into risk assessments that they’re imperfect,” Kowey said. “We’re merely trying to get some idea of approximate risk.”
Kowey pointed to something that he repeatedly mentions in his book “Failure to Treat: How a Broken Healthcare System Puts Patients and Practitioners at Risk”—that patients should build a relationship with “a good primary care doctor who knows the literature and is able to give good advice.”
The primary care doctor can become a trusted adviser who helps patients decide whether additional testing is necessary, which tests might be needed, and how to interpret the results.
Still, no matter how many interventions we try, there’s always some uncertainty.
Kowey himself is an example of someone with a family history of cardiovascular disease. He takes a statin and metformin for pre-diabetes.
“I hope that I’m reducing my risk, but unfortunately, there is a great unpredictability here that we simply are not able to completely manage,” he said. “It’s a fact of life.”