{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:12:20Z","timestamp":1793293940515,"version":"4.5.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with acute coronary syndrome without standard modifiable cardiovascular risk factors (SMuRFs; hypertension, smoking, dyslipidemia, diabetes) have not been well studied, with little known about their characteristics, quality of care, or outcomes. We sought to systematically analyze patients with ACS without SMuRFs, especially to evaluate the effectiveness of guideline\u2010directed medical therapy for these patients.<\/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\">In the CCC\u2010ACS (Improving Care for Cardiovascular Disease in China\u2010Acute Coronary Syndrome) project (2014\u20132019), we examined the presence and absence of SMuRFs and features among 89\u2009462 patients with initial acute coronary syndrome. The main outcome was in\u2010hospital all\u2010cause mortality. Among eligible patients, 11.0% had none of the SMuRFs (SMuRF\u2010less). SMuRF\u2010less patients had higher in\u2010hospital mortality (unadjusted hazard ratio [HR], 1.49 [95% CI, 1.19\u20131.87]). After adjustment for clinical characteristics and treatments, the associations between SMuRF status and in\u2010hospital mortality persisted (adjusted HR, 1.35 [95% CI, 1.07\u20131.70]). Guideline\u2010directed optimal medical therapy (receiving angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers, \u03b2\u2010blockers, and statins) was not associated with lower mortality (adjusted HR, 0.98 [95% CI, 0.58\u20131.67]) in SMuRF\u2010less patients, unlike the association in patients with SMuRFs (adjusted HR, 0.80 [95% CI, 0.66\u20130.98]). Sensitivity analyses were consistent with these results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">SMuRF\u2010less patients were associated with an increased risk of in\u2010hospital mortality. Guideline\u2010directed medical therapy was less effective in SMuRF\u2010less patients than in patients with SMuRFs. Dedicated studies are needed to confirm the optimal therapy for SMuRF\u2010less patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>REGISTRATION<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02306616.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.029252","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T09:28:55Z","timestamp":1726651735000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["In\u2010Hospital Mortality and Treatment in Patients With Acute Coronary Syndrome With and Without Standard Modifiable Cardiovascular Risk Factors: Findings From the CCC\u2010ACS Project"],"prefix":"10.1161","volume":"13","author":[{"given":"Wei","family":"Gong","sequence":"first","affiliation":[{"name":"Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China"},{"name":"National Clinical Research Center for Cardiovascular Diseases Beijing China"},{"name":"Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8399-4818","authenticated-orcid":false,"given":"Yan","family":"Yan","sequence":"additional","affiliation":[{"name":"Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China"},{"name":"National Clinical Research Center for Cardiovascular Diseases Beijing China"},{"name":"Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3311-0818","authenticated-orcid":false,"given":"Jing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8420-8911","authenticated-orcid":false,"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China"},{"name":"National Clinical Research Center for Cardiovascular Diseases Beijing China"},{"name":"Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing 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