Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors: JACC State-of-the-Art Review.

Gemma A Figtree; Stephen T Vernon; Jason A Harmer; Michael P Gray; Clare Arnott; Eric Bachour; Giannie Barsha; David Brieger; Alex Brown; David S Celermajer; Keith M Channon; Nicholas W S Chew; James J H Chong; Clara K Chow; Peter A Cistulli; Patrick T Ellinor; Stuart M Grieve; Tomasz J Guzik; Emil Hagström; Alicia Jenkins; Garry Jennings; Anthony C Keech; Katharine A Kott; Leonard Kritharides; Mamas A Mamas; Roxana Mehran; Peter J Meikle; Pradeep Natarajan; Kazuaki Negishi; John O'Sullivan; Sanjay Patel; Peter J Psaltis; Julie Redfern; Philippe G Steg; David R Sullivan; Johan Sundström; Birgit Vogel; Andrew Wilson; Dennis Wong; Deepak L Bhatt; Jason C Kovacic; Stephen J Nicholls;
Abstract
Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed.
Journal JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN 1558-3597
Published 26 Sep 2023
Volume 82
Issue 13
Pages 1343 1359 1343-1359
DOI 10.1016/j.jacc.2023.06.045
Type Journal Article | Review | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov't
Sponsorship