{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:06:26Z","timestamp":1793826386288,"version":"4.6.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,8,2]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">A significant proportion of patients with ST\u2010segment\u2013elevation myocardial infarction (MI) have no standard modifiable cardiovascular risk factors (SMuRFs) and have unexpected worse 30\u2010day outcomes compared with those with SMuRFs. The aim of this article is to examine outcomes of patients with non\u2013ST\u2010segment\u2013elevation MI in the absence of SMuRFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Presenting features, management, and outcomes of patients with non\u2013ST\u2010segment\u2013elevation MI without SmuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were compared with those with SmuRFs in the Swedish MI registry SWEDEHEART (Swedish Web\u2010System for Enhancement and Development of Evidence\u2010Based Care in Heart Disease Evaluated According to Recommended Therapies; 2005\u20132018). Cox proportional hazard models were used. Out of 99\u2009718 patients with non\u2013ST\u2010segment\u2013elevation MI, 11\u2009131 (11.2%) had no SMuRFs. Patients without SMuRFs had higher all\u2010cause and cardiovascular mortality at 30\u2009days (hazard ratio [HR], 1.20 [95% CI, 1.10\u20131.30],\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001; and HR, 1.25 [95% CI, 1.13\u20131.38]), a difference that remained after adjustment for age and sex. SMuRF\u2010less patients were less likely to receive secondary prevention statins (76% versus 82%); angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockade (54% versus 72%); or \u03b2\u2010blockers (81% versus 87%,\n                      <jats:italic>P<\/jats:italic>\n                      for all &lt;0.0001), with lowest rates observed in women without SMuRFs. In patients who survived to 30\u2009days, rates of all\u2010cause and cardiovascular death were lower in patients without SMuRFs compared with those with risk factors, over 12\u2009years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">One in 10 patients presenting with non\u2013ST\u2010segment\u2013elevation MI present without traditional risk factors. The excess 30\u2010day mortality rate in this group emphasizes the need for both improved population\u2010based strategies for prevention of MI, as well as the need for equitable evidence\u2010based treatment at the time of an MI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.024818","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T08:05:47Z","timestamp":1658736347000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Mortality and Cardiovascular Outcomes in Patients Presenting With Non\u2013ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5080-6083","authenticated-orcid":false,"given":"Gemma A.","family":"Figtree","sequence":"first","affiliation":[{"name":"Kolling Institute, Royal North Shore Hospital and University of Sydney Sydney Australia"},{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-0916","authenticated-orcid":false,"given":"Stephen T.","family":"Vernon","sequence":"additional","affiliation":[{"name":"Kolling Institute, Royal North Shore Hospital and University of Sydney Sydney Australia"},{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nermin","family":"Hadziosmanovic","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2247-8454","authenticated-orcid":false,"given":"Johan","family":"Sundstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University Uppsala Sweden"},{"name":"The George Institute for Global Health UNSW Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joakim","family":"Alfredsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Monash Cardiovascular Research Centre Victorian Heart Institute, Monash University Clayton Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4693-0038","authenticated-orcid":false,"given":"Clara K.","family":"Chow","sequence":"additional","affiliation":[{"name":"Westmead Applied Research Centre, Faculty of Medicine and Health University of Sydney Australia"},{"name":"Department of Cardiology Westmead Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0222-5468","authenticated-orcid":false,"given":"Peter","family":"Psaltis","sequence":"additional","affiliation":[{"name":"Vascular Research Centre South Australian Health and Medical Research Institute; Adelaide Medical School, University of Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2114-3134","authenticated-orcid":false,"given":"Helge","family":"R\u00f8sj\u00f8","sequence":"additional","affiliation":[{"name":"Akershus University Hospital L\u00f8renskog Norway"},{"name":"University of Oslo Norway"},{"name":"Uppsala Clinical Research Centre Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1677-1566","authenticated-orcid":false,"given":"Margr\u00e9t","family":"Le\u00f3sd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Faculty of Medicine Lund University Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University Uppsala Sweden"},{"name":"Uppsala Clinical Research Centre Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.47.4_Pt_2.4"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316679522"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00272-5"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013296"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317720287"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000087480.94275.97"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.198804"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.3109\/14017431.2013.780389"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-450"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.7.898"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvab145"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/micc.12488"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2021.05.004"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11911-8"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.07.079"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw450"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaa030"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00430"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107477"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.01.004"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017759"}],"updated-by":[{"DOI":"10.1161\/jaha.121.027668","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000}}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.024818","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:15:08Z","timestamp":1715584508000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.024818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,2]]},"references-count":21,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2022,8,2]]}},"alternative-id":["10.1161\/JAHA.121.024818"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.024818","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,2]]},"assertion":[{"value":"2021-11-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e024818"}}