10 Jul 2023 • Patients without standard modifiable cardiovascular risk factors (SMuRFs) who present with acute MI are at an increased risk of dying when compared with those who present with at least one risk factor, according to an analysis published recently in the Journal of the American Heart Association.

Overall, the mortality risk was two to three times higher in acute MI patients without modifiable CVD risk factors, such as high cholesterol or blood pressure. “Especially when it’s a younger patient, those without standard modifiable cardiovascular risk factors are much less likely to get the standard of care for acute coronary syndrome,” senior investigator Dr. Arman Qamar.

• In the YOUNG-MI registry, for example, 17% of patients younger than 50 years who presented with an acute MI lacked traditional risk factors.
• Data from an Australian registry showed an increasing trend in STEMI patients without traditional risk factors, with the proportion rising from 14% in 1999 to 23% in 2017.
• Australian researchers have shown previously that these SMuRF-less patients with STEMI are at a higher risk of early and late mortality.
• Using data from the Atherosclerosis Risk in Communities (ARIC) study, researchers identified 20,569 patients hospitalized for acute MI between 2000 and 2014
• At 28 days, patients without SMuRFs had a significantly higher rate of all-cause mortality compared with those with at least one risk factor (16% vs 6%)

Qamar stressed that while high blood pressure, high LDL-cholesterol level, diabetes, and smoking are important CVD risk factors, there’s accumulating evidence highlighting the role of emerging or novel risk factors. For example, lipoprotein(a) is now recognized as an important predictor of risk. Moreover, there are other factors, such as air pollution, stress, sleep duration, and substance abuse, that have been shown to be associated with heightened CVD risk.

Source: tctMD | Read full story