The key to preventing heart disease may lie in detecting it long before any symptoms appear.
Imagine if doctors could predict your risk of a heart attack years before any warning signs emerged.
This vision is becoming a reality through groundbreaking research happening right in Miami. Studies like the Miami Heart Study and the Hispanic Community Health Study are revolutionizing how we understand cardiovascular risk by focusing on the "preclinical" phase—the period when hidden biological changes are already underway, long before any clinical symptoms appear. By combining advanced imaging technology with comprehensive health assessments, researchers are developing sophisticated models to identify at-risk individuals earlier than ever before, potentially transforming preventive medicine and saving countless lives.
Cardiovascular disease remains the leading cause of death nationwide, with someone dying from it every 33 seconds in the United States 6 . Traditional risk assessment often focuses on known factors like high blood pressure, diabetes, and cholesterol levels, but by the time these are identified, significant damage may have already occurred.
Preclinical risk assessment represents a paradigm shift—it aims to identify vulnerability long before disease manifests. The power of this approach lies in its potential to prevent heart attacks rather than just treat them after they happen.
"The field of cardiovascular prevention is about taking people with high-risk cardiac or other medical conditions, and preventing a heart attack, stroke, heart failure and death," explains Dr. Jonathan Fialkow, deputy medical director and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute 7 .
The Miami Heart Study (MiHeart), launched in 2015 by Baptist Health Miami Cardiac & Vascular Institute, represents one of the most ambitious efforts to refine preclinical risk assessment. Its innovative approach focuses exclusively on asymptomatic individuals—volunteers aged 40-65 with no established cardiovascular disease or symptoms when recruited 7 .
What sets this study apart is its use of coronary computed tomography angiography (CCTA) for baseline testing. This sophisticated imaging technique provides detailed, 3D images of blood vessels and tissues, allowing researchers to identify plaque buildup long before it causes symptoms 7 .
The initial findings were startling: 49% of asymptomatic participants had coronary plaque, and 6% had artery narrowing greater than 50%—the most serious risk factor for heart attack if untreated 7 . These findings demonstrate that heart disease can develop silently in apparently healthy individuals.
A major next phase for MiHeart involves comprehensive follow-up with participants approximately five years after their initial assessment. Researchers are conducting extensive surveys and retesting to determine:
What happened to patients who developed heart disease
Which parameters predicted worsening condition
What factors helped others improve or avoid heart disease entirely 7
Future projects will delve even deeper, with plans for full gene DNA sequencing of participants to identify genetic markers associated with coronary artery disease development 7 .
Parallel to the Miami Heart Study, another landmark research initiative is advancing our understanding of cardiovascular risk in specific populations. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), with a recent $21 million grant extension from the National Institutes of Health, represents the most comprehensive epidemiological longitudinal study among U.S. Hispanics/Latinos .
"Findings from the ongoing research, including dozens of related studies that build off the cohort, are influencing clinical care and prevention strategies," says Dr. Frank Penedo, principal investigator for the HCHS/SOL study and associate director for population sciences at Sylvester Comprehensive Cancer Center .
Higher rates of diabetes have been identified in participants of Mexican and Central and South American backgrounds
More than 40% of diabetic individuals in the cohort were unaware of their condition
Multiple barriers impact cancer screening behaviors, which generally don't meet recommended prevention guidelines
To make preclinical risk assessment practical for population-wide use, researchers have developed sophisticated modeling approaches that can accurately predict heart attack risk using accessible data. One recent study published in medRxiv demonstrates how a staged modeling approach using self-reported data can achieve strong predictive power 6 .
This research analyzed data from 100,000 participants from the Behavioral Risk Factor Surveillance System 2023, employing a four-stage model that sequentially adds categories of risk factors 6 .
| Stage | Components Added | Purpose |
|---|---|---|
| 1 | Demographic factors (age, sex, race, income, education) | Establish baseline demographic risk profile |
| 2 | Diabetes status | Add metabolic disease component |
| 3 | Hypertension status | Incorporate cardiovascular stressor |
| 4 | Cholesterol status | Include lipid profile factor |
The research identified several powerful predictors of heart attack risk 6 :
OR=6.58, 95% CI: 5.37-8.06
OR=1.81
OR=1.77
OR=1.50
Notably, the study also found protective associations, including female sex (OR=0.49) and having a college education (OR=0.42) 6 .
The advancement of preclinical cardiovascular risk assessment depends on sophisticated methodological tools and approaches. Here are key components powering this research:
| Tool/Resource | Function | Application in Research |
|---|---|---|
| Coronary Computed Tomography Angiography (CCTA) | Provides detailed 3D images of blood vessels and heart tissues | Identifies plaque buildup and artery narrowing in asymptomatic individuals 7 |
| Coronary Artery Calcium (CAC) Scoring | Measures calcified plaque in coronary arteries through CT imaging | Quantifies plaque deposits; scores >300 indicate high heart disease risk 7 |
| Multiple Imputation using Chained Equations (MICE) | Statistical technique for handling missing data in large datasets | Maintains data integrity and strengthens conclusions in epidemiological studies 6 |
| Staged Modeling Approach | Sequential addition of risk factor categories to prediction models | Systematically evaluates incremental value of different risk factors 6 |
| Bio-banked Blood and Serum Samples | Preservation of biological specimens for future analysis | Enables genetic and molecular research, including DNA sequencing 7 |
The work underway in Miami has far-reaching implications for the future of cardiovascular medicine. By identifying at-risk populations earlier and with greater precision, healthcare providers can implement targeted interventions before irreversible damage occurs.
The Miami Heart Study's finding that nearly half of asymptomatic middle-aged adults have significant coronary plaque suggests we may need to rethink our approach to routine health screenings 7 .
The Hispanic Community Health Study's revelation that over 40% of diabetic participants were unaware of their condition highlights critical gaps in our current healthcare delivery systems .
As these studies continue to evolve, incorporating emerging technologies like artificial intelligence and machine learning, their potential to reshape preventive cardiology only grows. The DNA sequencing component planned for the Miami Heart Study may uncover genetic markers that further refine our risk prediction models 7 .
The groundbreaking research happening in Miami represents a fundamental shift from reactive treatment to proactive prevention of cardiovascular disease. By focusing on the preclinical phase—that critical window when interventions can be most effective—studies like the Miami Heart Study and the Hispanic Community Health Study are developing the tools to detect vulnerability long before symptoms appear.
| Finding | Percentage of Participants | Significance |
|---|---|---|
| Any coronary plaque | 49% | Nearly half of asymptomatic adults have early signs of heart disease |
| Artery narrowing >50% | 6% | Significant number face high heart attack risk without knowing it |
| Participants with at least one cardiovascular risk factor | 71-80% | Varies by gender and population |
As these efforts continue to generate valuable data and refine risk models, they move us closer to a future where heart attacks are predictable and preventable rather than sudden and devastating. The work underscores a powerful message: when it comes to heart health, what we don't know can hurt us, but through advanced preclinical risk assessment, we're learning to see the invisible and protect the vulnerable.