Post

Your Heart Risk Score Is Probably Wrong

New cardiology evidence suggests we’re missing high-risk patients—and treating too late.

2 min read
cardiology prevention screening heart disease analysis
On this page

Hook

What if your “low-risk” heart score is wrong?

A major 2025 review in the Journal of the American College of Cardiology suggests that’s not just possible—it’s common.

Context

For decades, cardiovascular prevention has relied on risk calculators.

Age, cholesterol, blood pressure, smoking → plug into a model → decide whether to treat.

But these models were built on population averages—and they miss individual risk.

Now, newer tools are changing the picture:

  • Coronary artery calcium (CAC) scans
  • Lipoprotein(a)
  • Apolipoprotein B (ApoB)

Together, they can reveal hidden risk long before symptoms appear.

Your Take

We’ve built an entire prevention system around thresholds.

Wait until risk crosses a line → then act.

The problem?

Atherosclerosis doesn’t wait.

By the time someone qualifies for treatment, disease is often already established.

The shift happening now is subtle but important:

👉 From reactive thresholds
👉 To early detection and personalised risk

This isn’t about treating everyone earlier.

It’s about treating the right people earlier.

Implications

If this shift holds, it changes how we think about prevention:

  • “Low risk” may not mean safe
  • Imaging will become routine in borderline cases
  • Biomarkers will refine who actually needs treatment

For patients, it means asking better questions:

  • Should I get a CAC scan?
  • Do I know my ApoB or Lp(a)?
  • Is my risk being underestimated?

For clinicians, it means moving beyond checklists.

FAQ

Q: Are current risk calculators useless?
A: No—they’re still useful as a starting point. But they miss individual variation.

Q: Who should consider additional testing?
A: People with borderline risk, family history, or metabolic risk factors.

Q: Does this mean everyone needs a scan?
A: No. The goal is better targeting—not more testing for everyone.

Further Reading

Closing

The future of prevention isn’t more treatment.

It’s better timing.

And right now—we’re often too late.