Silent CAD – The Limitations of Current CAD Tests
In many cases, CAD develops silently, with no symptoms until a sudden cardiovascular event occurs. Studies also show that 50% of men and 64% of women who suffer a fatal heart attack had no prior warning symptoms, averaging approximately 57% across genders⁷. An important fact is that nearly 45% of sudden cardiac deaths (SCDs) happen in people with no history of heart disease¹⁷.
And in 90% of these cases, doctors did not diagnose it until after death¹⁷. This asymptomatic character is critical in healthcare. By the time symptoms appear or a stress test is done, coronary narrowing can already be severe. This limits the effectiveness of preventive therapy⁶ and highlights the urgent, unmet need: earlier, highly accessible CAD assessment for at-risk patients before irreversible damage occurs.
of men who suffer a fatal heart attack had no prior warning symptoms
of women who suffer a fatal heart attack had no prior warning symptoms
of sudden cardiac deaths happen in people with no history of heart disease
of these cases were not diagnosed until after death
Why CAD Often Goes Undetected
Coronary artery disease (CAD) usually involves blockages in the main coronary arteries. This leads to myocardial ischemia. Myocardial ischemia happens when the heart’s need for oxygen does not match its supply.
Plaque builds up
Coronary arteries slowly narrow, often without any symptoms
Ischaemia develops
The heart’s oxygen supply no longer matches its demand
Detected too late
Current tests pick it up once the disease is already advanced
This ischaemia-centric model, despite being present for centuries, has shown limitations in clinical practice. By the time ischaemia is detectable, the disease is often already advanced, limiting opportunities for preventive care and making treatment more invasive and costly⁸.
Why Improved CAD Awareness Matters
Coronary artery disease (CAD) does not always announce itself with clear symptoms, and when symptoms do occur, they can be misleading or attributed to other conditions. This diagnostic uncertainty makes early detection challenging. In fact, a large-scale study published in the New England Journal of Medicine found that over 60% of patients referred for elective coronary angiography did not have obstructive CAD, despite being referred based on symptoms or noninvasive testing⁹. This points to major weak spots in current screening methods.
High False Positives in Symptom-Based CAD Screening
Even in patients with symptoms, available risk screening tests are less than ideal. Studies show that 4 out of 5 patients sent for testing don’t have obstructive coronary artery disease (CAD). Most tests come back negative, yet many patients still go through extra procedures and face higher costs, even though they’re not truly at risk⁴.
This over-referral leads to:
- Improper usage of limited healthcare resources
- Unnecessary patient anxiety
- High system costs
- Delays in identifying those truly at risk
Not only is CAD underdiagnosed, it is overexamined in the wrong populations.
Diagnostic Gaps Across Care Settings
The issue is not limited to general practice. Across hospitals and clinics, healthcare professionals decide who gets tested for coronary artery disease (CAD) based on a person’s symptoms. But these symptoms don’t always match the real disease, so many cases go missed or misjudged.
As a result:
Reactive
Designed to confirm disease only after symptoms appear
Proactive
Early CAD screening, especially in patients with multiple risk factors
Current screening technology is reactive, designed to confirm disease only after symptoms appear. The true opportunity lies in shifting to proactive early CAD screening, especially in patients with multiple risk factors. This shift not only improves clinical outcomes, but also significantly reduces the burden on healthcare.
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References
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