New artificial intelligence tools are offering increasingly precise methods for assessing cardiovascular risk, but proactive heart health management remains crucial today.Understanding your individual risk factors for heart disease-the leading cause of death in Italy-can be as simple as a conversation with your doctor and a routine blood test. This article explores both the exciting potential of AI in cardiology and the readily available steps individuals can take to safeguard thier heart health.
Artificial intelligence may soon offer a more precise way to estimate cardiovascular risk, but there’s much that can be done today. Understanding your heart health and calculating your risk of developing heart disease starts with a conversation with your doctor and a simple blood test.
How old is your heart, really? Knowing the answer could be incredibly valuable in assessing your risk of cardiovascular events like heart attack and stroke – which remain the leading cause of death in Italy – and determining that age may be surprisingly straightforward. Researchers are exploring the use of artificial intelligence to analyze standard electrocardiograms (ECGs) and provide a more accurate assessment of heart health.
A recent study presented at the European Heart Rhythm Association congress involved “training” an AI algorithm on over half a million ECGs collected over a 15-year period. The algorithm was able to estimate the biological age of the hearts analyzed and, crucially, correlate that age with the risk of mortality, heart attack, and stroke. It makes intuitive sense that a 50-year-old with the heart of a 70-year-old would face a higher risk of cardiovascular problems than someone the same age with the heart of a 30-year-old. The study found that even a biological heart age just seven years older than chronological age could increase the probability of a cardiovascular event by as much as 92 percent, while a heart seven years “younger” could reduce that risk by 27 percent. While AI promises to refine cardiovascular risk assessment in the future, many effective tools are already available to evaluate heart health and determine if preventative measures are needed.
Talk to Your Doctor
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You don’t need advanced technology to assess your heart health, nor do you need to know your heart’s biological age, though it can provide valuable context. A simple conversation with your primary care physician is a great starting point. Doctors can calculate your cardiovascular risk using tools like the “risk chart” developed by the Italian National Heart Project. This tool, recommended for individuals over 40, estimates the probability of a heart attack or similar event within the next 10 years, helping to determine if and how intervention is necessary.
Blood Pressure
The risk chart considers six factors: sex, age, smoking status, and three measurements taken by a doctor – blood pressure, cholesterol, and blood sugar levels. Analyzing certain blood parameters can provide a realistic picture of heart health, as explained by Massimo Grimaldi, president of the National Association of Hospital Cardiologists (ANMCO): “The first fundamental element is lipid levels. It’s important to look not so much at triglycerides, which are heavily influenced by diet, but especially at total cholesterol and its fractions – HDL (“good” cholesterol) and LDL (“bad” cholesterol), which are more dependent on metabolism and the liver, and only about 10 percent on what we eat.”
Cholesterol
LDL cholesterol silently accumulates on artery walls, forming plaques that thicken and can obstruct blood flow or cause blood clots. These clots can break off and cause heart attacks or strokes. Therefore, high cholesterol is now considered a direct cause of cardiovascular events, not just a risk factor. As Grimaldi explains, “It’s important to start monitoring cholesterol around age 35 or 40 and intervene if necessary to keep it within healthy limits – which vary depending on individual cardiovascular risk factors. The earlier cholesterol is brought under control, the better.”
Lipoprotein(a)
Recent guidelines from the European Society of Cardiology emphasize the need to expand lipid profiles to include lipoprotein(a), a “new” cholesterol not determined by diet or metabolism but by genetics. Lipoprotein(a) acts as a powerful amplifier of cardiovascular risk. Experts recommend that everyone have it measured at least once, as elevated levels (above 50 milligrams per deciliter) – in the absence of specific medications – highlight the importance of controlling all other risk factors, including cholesterol.
Blood Sugar
“Another key parameter is blood sugar, as the presence of type 2 diabetes significantly increases the probability of cardiovascular events,” says Grimaldi. “For a more complete picture, it can be helpful to measure C-reactive protein, an indicator of inflammation that, when elevated, increases the risk of dangerous blood clots. The same applies to fibrinogen, a marker of inflammation and coagulation activation that should be monitored. Routine testing should also include creatinine levels to assess kidney function: healthy kidneys are a reflection of overall health, and kidney problems significantly increase cardiovascular risk.” Additional new markers entering clinical practice for monitoring heart health include NT-proBNP (a fragment of a protein produced by the heart under stress) – an indicator of heart failure and overload – and high-sensitivity troponin, a marker of heart damage that can help with early diagnosis of heart problems.
Standard ECG
Pasquale Perrone Filardi, president of the Italian Society of Cardiology (SIC), adds, “When assessing cardiovascular risk and heart health, it’s also important to consider factors that amplify danger, such as obesity and obstructive sleep apnea. In women, diabetes during pregnancy, preeclampsia, or early menopause are also significant. In addition to blood tests and assessing risk factors, an electrocardiogram (ECG) is valuable.” The test evaluates the electrical activity of the heart and can provide information about many diseases. Grimaldi notes, “It should be performed for the first time between ages six and eight to assess the presence of potential genetic conditions that could increase the risk of death from arrhythmias, and again by age 30 to detect other dangerous conditions like Brugada syndrome.” “It’s included in occupational and sports medicine exams, so many people undergo it. After age 70, it’s important for detecting atrial fibrillation, which affects about one in ten people and, if undiagnosed and untreated, significantly increases the risk of stroke. A standard ECG cannot evaluate heart contractility or valve damage, but AI may expand the diagnostic capabilities of this traditional test.”
Stress ECG
When should a stress ECG – which measures electrical activity while running on a treadmill or cycling – be performed? “It should always be done for competitive athletes and if heart problems are suspected,” Grimaldi responds, “because the increased heart rate induced by exercise more easily reveals arrhythmias, conduction disturbances, and reduced blood flow to the heart (for example, if there are coronary artery diseases that could lead to a heart attack).” A stress ECG is therefore considered a second-level test, as Perrone Filardi confirms: “To understand where we fall on the risk spectrum, standard tests are sufficient. If there are diagnostic suspicions or symptoms like shortness of breath or pain when the heart rate increases, it’s best to undergo a stress ECG or echocardiogram.”
Screening
Given that heart and vascular diseases remain the leading cause of death in Italy, would a more structured screening program be beneficial, similar to those for certain types of cancer? “Absolutely, because once the disease is present, the damage is done: the only possible strategy is prevention and early diagnosis,” Grimaldi replies. “Heart failure, for example, has a 50 percent mortality rate five years after diagnosis – higher than many cancers for which screening exists and are less common. The burden of cardiovascular disease is particularly felt after age 65: a program with a few simple, inexpensive tests between ages 50 and 65 could reduce illness and improve longevity.”
The Cardio-Renal-Metabolic Syndrome
Few people are aware of the cardio-renal-metabolic syndrome, but a recent American Heart Association study found that 90% of the U.S. population has at least one of the defining elements: obesity, diabetes, high blood pressure or cholesterol, and reduced kidney function. The study also showed that only 12% of citizens have even heard of the syndrome, and 42% believe a healthy heart cannot be damaged by problems with the renal or metabolic system. However, there is a close connection between renal, metabolic, and heart health: a heart attack or stroke can be the culmination of a process that begins elsewhere, with excess weight or uncontrolled blood sugar, or with stressed kidneys. Everything is connected, which means that therapies must also be coordinated. The first guidelines for managing the syndrome are expected to be released in early 2026, and it is estimated to affect over 11 million people in Italy.
Coronary CT Scan
AI could also help interpret coronary CT scans, used to evaluate narrowing of the coronary arteries in people at low to moderate risk. A recent consensus document in Nature Reviews Cardiology highlights that algorithms could improve the diagnostic accuracy of the test, which is already reliable and provides refined imaging but requires skilled interpretation, especially when measuring the calcium score – the “score” indicating how much calcium is present in coronary plaques. It’s not always true that more calcium means a higher risk to the heart; non-calcified plaques are often less stable and therefore more dangerous, while calcium-rich plaques are sometimes more “stable,” especially in people who are physically active. Evaluating a coronary CT scan is therefore complex, and AI could provide a valuable contribution.
