PMID- 28703626 OWN - NLM STAT- MEDLINE DCOM- 20180709 LR - 20220331 IS - 2047-4881 (Electronic) IS - 2047-4873 (Linking) VI - 24 IP - 17 DP - 2017 Nov TI - Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. PG - 1824-1830 LID - 10.1177/2047487317720287 [doi] AB - 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. FAU - Vernon, Stephen T AU - Vernon ST AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. AD - 2 Sydney Health Partners, Australia. FAU - Coffey, Sean AU - Coffey S AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. AD - 3 Dunedin School of Medicine, University of Otago, New Zealand. FAU - Bhindi, Ravinay AU - Bhindi R AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. AD - 2 Sydney Health Partners, Australia. FAU - Soo Hoo, Soon Yeng AU - Soo Hoo SY AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. FAU - Nelson, Gregory I AU - Nelson GI AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. FAU - Ward, Michael R AU - Ward MR AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. FAU - Hansen, Peter S AU - Hansen PS AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. FAU - Asrress, Kaleab N AU - Asrress KN AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. AD - 2 Sydney Health Partners, Australia. FAU - Chow, Clara K AU - Chow CK AD - 2 Sydney Health Partners, Australia. AD - 4 The George Institute for Global Health, Sydney, Australia. AD - 5 Department of Cardiology, Westmead Hospital, Sydney, Australia. FAU - Celermajer, David S AU - Celermajer DS AD - 2 Sydney Health Partners, Australia. AD - 6 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. FAU - O'Sullivan, John F AU - O'Sullivan JF AD - 2 Sydney Health Partners, Australia. AD - 7 Heart Research Institute, Sydney, Australia. FAU - Figtree, Gemma A AU - Figtree GA AD - 1 Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia. AD - 2 Sydney Health Partners, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20170713 PL - England TA - Eur J Prev Cardiol JT - European journal of preventive cardiology JID - 101564430 SB - IM CIN - Eur J Prev Cardiol. 2017 Nov;24(17):1819-1823. PMID: 28969497 MH - Aged MH - Aged, 80 and over MH - Chi-Square Distribution MH - Coronary Artery Disease/diagnosis/*epidemiology/mortality/therapy MH - Diabetes Mellitus/diagnosis/*epidemiology/mortality/therapy MH - Female MH - Humans MH - Hypercholesterolemia/diagnosis/*epidemiology/mortality/therapy MH - Hypertension/diagnosis/*epidemiology/mortality/therapy MH - Linear Models MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - New South Wales/epidemiology MH - Odds Ratio MH - Primary Prevention MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - ST Elevation Myocardial Infarction/diagnosis/*epidemiology/mortality/therapy MH - Secondary Prevention MH - Smoking/adverse effects/*epidemiology/mortality MH - Time Factors OTO - NOTNLM OT - Myocardial infarction OT - atherosclerosis OT - coronary artery disease OT - risk factors EDAT- 2017/07/14 06:00 MHDA- 2018/07/10 06:00 CRDT- 2017/07/14 06:00 PHST- 2017/07/14 06:00 [pubmed] PHST- 2018/07/10 06:00 [medline] PHST- 2017/07/14 06:00 [entrez] AID - 10.1177/2047487317720287 [doi] PST - ppublish SO - Eur J Prev Cardiol. 2017 Nov;24(17):1824-1830. doi: 10.1177/2047487317720287. Epub 2017 Jul 13.