Data Suggest ASCVD Scores Overlook Atherosclerosis in Low, Borderline-Risk Patients: Anna Mueller, MD

In new research presented by Anna Mueller, MD, from the Icahn School of Medicine at Mount Sinai, imaging-based screening demonstrated a significant impact on cardiovascular disease (CVD) risk assessment and prevention. The research featured at the American College of Cardiology 2025 Annual Scientific Session (ACC.25) found that targeting treatment based on the presence of subclinical atherosclerosis (AS), rather than relying solely on ASCVD risk scores, resulted in a 98% relative risk reduction in cardiovascular events. Additionally, nearly 42% of low-risk and 69% of borderline-risk individuals had detectable AS, suggesting that traditional risk scoring may underestimate disease presence in certain populations.

In an interview with The American Journal of Managed Care^®, Mueller emphasized that while imaging could revolutionize preventive cardiology, critical questions remain regarding the optimal timing, frequency, and cost-effectiveness of screening. She noted that broader adoption of imaging will depend on further research, including randomized controlled trials, to refine its role in clinical practice and potentially reshape screening guidelines in the coming years.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Based on your findings, should imaging-based screening be expanded beyond the intermediate-risk group in the future? What are the next steps to refining how imaging can be integrated into preventive cardiology?

I do think that the future will be that we will screen patients for atherosclerosis with some kind of imaging-based screening tool, maybe ultrasound, [coronary artery] calcium score, CTA [CT angiography]. Again, I think there's just so much great research going on right now, and I think we just need to clarify at what time point should we start screening, which is the right imaging tool? What are the intervals? What could be the potential side effects from repeating imaging? There's just a lot of things we still need to answer.

I still personally think that this is the future. Because I do think that nothing, no estimator, no estimation, will ever be as good as actually looking if someone has disease; it's just never going to be the same. In the end, if you want to be precise and correct about treating someone, I think if you have an imaging study, it will lead to the least amount of errors. And given the fact that cardiovascular disease is the leading factor for mortality in the world, I think it's worth investigating and worth spending money and more research on this whole thing.

Your research indicates potential for image-based screening to improve cardiovascular risk assessment, but access to advanced imaging varies. What are some barriers to broader adoption of this approach?

I think there are many barriers at the moment. I mean, I'm biased; I think this is a great study, but this is a retrospective analysis. So, I think this should be used as a thought-provoking idea to create more research studies based on this project. We need controlled randomized studies. We need cost-effective analysis. We need analyses on how often imaging studies need to be repeated in order to be accurate.

There's so much more research that needs to be done, and hopefully, that will clarify what imaging studies should be used and who would benefit from it. Once we have clarified those answers, maybe guidelines will change, and hopefully, with that, it will allow access to more people for imaging studies. I hope it's going to be in the next 5 to 10 years, but we'll see how long it takes.

References

Mueller, A, Nasibi N, Zamani T, et al. Subclinical atherosclerosis detection: the importance of imaging in low and borderline risk populations. Presented at ACC.25; March 29-31, 2025; Chicago, Illinois. Session 243-22.