Article

Aims Identification and management of the Standard Modifiable Cardiovascular Risk
Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) has
substantially improved cardiovascular disease outcomes. However, cardiovascular
disease remains the leading cause of death worldwide. Suspecting an evolving
pattern of risk factor profiles in the ST elevation myocardial infarction (STEMI)
population with the improvements in primary care, we hypothesized that the
proportion of 'SMuRFless' STEMI patients may have increased. Methods/results We
performed a single centre retrospective study of consecutive STEMI patients
presenting from January 2006 to December 2014. Over the study period 132/695
(25%) STEMI patients had 0 SMuRFs, a proportion that did not significantly change
with age, gender or family history. The proportion of STEMI patients who were
SMuRFless in 2006 was 11%, which increased to 27% by 2014 (odds ratio 1.12 per
year, 95% confidence interval: 1.04-1.22). The proportion of patients with
hypercholesterolaemia decreased (odds ratio 0.92, 95% confidence interval
0.86-0.98), as did the proportion of current smokers (odds ratio 0.93, 95%
confidence interval 0.86-0.99), with no significant change in the proportion of
patients with diabetes and hypertension. SMuRF status was not associated with
extent of coronary disease; in-hospital outcomes, or discharge prescribing
patterns. Conclusion The proportion of STEMI patients with STEMI poorly explained
by SMuRFs is high, and is significantly increasing. This highlights the need for
bold approaches to discover new mechanisms and markers for early identification
of these patients, as well as to understand the outcomes and develop new targeted
therapies.

Langue : ANGLAIS