Acute coronary syndrome without standard modifiable cardiovascular risk factors (SMuRF): More questions than answers

Standard modifiable cardiovascular risk factors (SMuRFs) such as diabetes, hyperlipidemia, hypertension, and smoking play a pivotal role in the pathogenesis of acute myocardial infarction (AMI). Addressing these potentially modifiable SMuRFs thus represents a pillar of primary and secondary prevention in contemporary cardiovascular medicine [ 1 Visseren F.L.J. Mach F. Smulders Y.M. Carballo D. Koskinas K.C. Back M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 2021; 42: 3227-3337 Crossref PubMed Scopus (1436) Google Scholar , 2 Reinstadler S.J. Stiermaier T. Eitel C. Metzler B. de Waha S. Fuernau G. et al. Relationship between diabetes and ischaemic injury among patients with revascularized ST-elevation myocardial infarction. Diabetes Obes. Metab. 2017; 19: 1706-1713 Crossref PubMed Scopus (23) Google Scholar , 3 Reindl M. Reinstadler S.J. Feistritzer H.J. Theurl M. Basic D. Eigler C. et al. Relation of low-density lipoprotein cholesterol with microvascular injury and clinical outcome in revascularized ST-elevation myocardial infarction. J. Am. Heart Assoc. 2017; 6 Crossref Scopus (30) Google Scholar , 4 Reinstadler S.J. Reindl M. Tiller C. Holzknecht M. Klug G. Metzler B. Obesity paradox in ST-elevation myocardial infarction: is it all about infarct size?. Eur. Hear J. Qual. Care Clin. Outcomes. 2018; 5: 180-182 Crossref Scopus (10) Google Scholar ]. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: Results from a global meta-analysis of 1,285,722 patientsInternational Journal of CardiologyVol. 371PreviewStandard modifiable cardiovascular risk factors (SMuRF), comprising diabetes, hyperlipidemia, hypertension, and smoking, are used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. Full-Text PDF