Cine Cardiac MRI Captures Cardiovascular Disease Risk Beyond Established Clinical Risk Factors: Evidence from the UK Biobank

Early and accurate risk stratification of cardiovascular disease (CVD) is crucial to initiate timely preventive interventions. As large-scale multimodal clinical cohorts become increasingly available, there is growing interest in whether incorporating additional sources of information can improve CVD risk stratification. Cine cardiac MR (CMR) represents a compelling example of such a source, as it captures objective, high-dimensional structural and functional information about the heart, independent of patient-reported data. In this study, we deploy a flexible vision-tabular method to incorporate cine CMR into CVD risk assessment together with structured clinical data. Using a large prospective imaging cohort from the UK Biobank, we show that cine CMR encodes CVD risk beyond established risk scores, increasing AUROC by 0.036 over SCORE2, the best-performing traditional risk score (0.742 vs. 0.706, \textit{p} = 0.04). Furthermore, we find that cine CMR achieves risk discrimination capabilities on par with automated, image-derived phenotypes, removing the dependency on segmentation pipelines. Lastly, we demonstrate that integrating cine CMR with clinical variables through a vision-tabular learning framework stabilizes risk prediction under real-world conditions of incomplete tabular data, a common challenge in clinical practice. Together, these findings position cine CMR as a promising modality for CVD risk assessment.