{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:43:34Z","timestamp":1784735014288,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T00:00:00Z","timestamp":1714176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Recent reports have highlighted myocardial infarction (MI) patients without standard modifiable risk factors (SMRF), noting them to be surprisingly common and to have a substantial risk of adverse outcomes. The objective of this study was to address the challenge of identifying at-risk patients without SMRF and providing preventive therapy. Methods: Patients presenting between 2001 and 2021 to Intermountain Health catheterization laboratories with a diagnosis of MI were included if they also had a coronary artery calcium (CAC) scan by computed tomography within 2 years. SMRF were defined as a clinical diagnosis or treatment of hypertension, hyperlipidemia, diabetes, or smoking. The co-primary endpoints in SMRF-less patients were: (1) proportion of patients with an elevated (&gt;50%ile) CAC score, and (2) an indication for statin therapy (i.e., CAC \u2265 100 AU or \u226575%ile). The 60-day and long-term major adverse cardiovascular events were determined. A comparison set included MI patients with SMRF. Results: We identified 429 MI patients with a concurrent CAC scan, of which 60 had no SMRF. SMRF status did not distinguish most risk factors or interventions. No-SMRF patients had a high CAC prevalence and percentile (82% \u2265 50%ile; median, 80%ile), and 77% met criteria for preventive therapy. As expected, patients with SMRF had high CAC scores and percentiles. Outcomes were more favorable for No-SMRF status and for lower CAC scores. Conclusions: Patients without SMRF presenting with an MI have a high prevalence and percentile of CAC. Wider application of CAC scans, including in those without SMRF, is promising as a method to identify an additional at-risk population for MI and to provide primary preventive therapy.<\/jats:p>","DOI":"10.3390\/jcm13092569","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T08:49:24Z","timestamp":1714380564000},"page":"2569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Coronary Calcium Is Elevated in Patients with Myocardial Infarction without Standard Modifiable Risk Factors"],"prefix":"10.3390","volume":"13","author":[{"given":"Jeffrey L.","family":"Anderson","sequence":"first","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Knight","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Dong","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi T.","family":"May","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6659-5332","authenticated-orcid":false,"given":"Viet T.","family":"Le","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"},{"name":"Rocky Mountain University of Health Professions, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tami L.","family":"Bair","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk U.","family":"Knowlton","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e013296","DOI":"10.1161\/JAHA.119.013296","article-title":"ST-segment-elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors\u2014How common are they, and what are their outcomes?","volume":"8","author":"Vernon","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1177\/2047487317720287","article-title":"Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors","volume":"24","author":"Vernon","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"876465","DOI":"10.3389\/fcvm.2022.876465","article-title":"Comparison of mortality outcomes in acute myocardial infarction patients with or without standard modifiable cardiovascular risk factors","volume":"9","author":"Sia","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_4","first-page":"101135","article-title":"Mortality in ST-segment elevation myocardial infarction patients without standard modifiable risk factors: A race disaggregated analysis","volume":"43","author":"Moledina","year":"2022","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/S0140-6736(21)00272-5","article-title":"Mortality in STEMI patients without standard modifiable risk factors: A sex-disaggregated analysis of SWEDEHEART registry data","volume":"397","author":"Figtree","year":"2021","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Anderson, J.L., Knight, S., May, H.T., Le, V.T., Almajed, J., Bair, T.L., Knowlton, K.U., and Muhlestein, J.B. (2023). Cardiovascular outcomes of ST-elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMURF-Less): The Intermountain Healthcare Experience. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010075"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kim, Y.H., Her, A.-Y., Rha, S.-W., Choi, C.U., Choi, B.G., Kim, J.B., Park, S., Kang, D.O., Park, J.Y., and Park, S.-H. (2022). Comparisons of clinical outcomes after non-ST-segment and ST-segment elevation myocardial infarction in diabetic and nondiabetic populations. J. Clin. Med., 11.","DOI":"10.3390\/jcm11175079"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1093\/eurjpc\/zwab200","article-title":"Addressing disparities of care in non-ST-segment elevation myocardial infarction patients without standard modifiable risk factors: Insights from a nationwide cohort study","volume":"29","author":"Moledina","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e024818","DOI":"10.1161\/JAHA.121.024818","article-title":"Mortality and cardiovascular outcomes in patients presenting with non-ST elevation myocardial infarction despite no standard modifiable risk factors: Results from the SWEDEHEART Registry","volume":"11","author":"Figtree","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Anderson, J.L., Knight, S., May, H.T., Le, V.T., Bair, T.L., Knowlton, K.U., and Muhlestein, J.B. (2023). Frequency and outcomes of patients presenting with non-ST elevation myocardial infarction (NSTEMI) without standard modifiable risk factors: A US healthcare experience. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093263"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jakubiak, G.K. (2024). Cardiac troponin serum concentration measurement is useful not only in the diagnosis of acute cardiovascular events. J. Pers. Med., 14.","DOI":"10.3390\/jpm14030230"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.jacc.2015.08.035","article-title":"10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)","volume":"66","author":"McClelland","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1016\/j.jacc.2018.11.002","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"73","author":"Grundy","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jcmg.2021.11.006","article-title":"Coronary artery calcium versus pooled cohort equations score for primary prevention guidance: Randomized feasibility trial","volume":"15","author":"Muhlestein","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e120949","DOI":"10.1172\/jci.insight.120949","article-title":"Implementation of a cardiac PET stress program: Comparison of outcomes to the preceding SPECT era","volume":"3","author":"Knight","year":"2018","journal-title":"JCI Insight"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1161\/CIRCULATIONAHA.119.045010","article-title":"Coronary artery calcium for personalized allocation of aspirin in primary prevention of cardiovascular disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis)","volume":"141","author":"Miedema","year":"2020","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1161\/01.CIR.93.11.1951","article-title":"Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects","volume":"93","author":"Arad","year":"1996","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.jcmg.2009.06.014","article-title":"Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up MESA (Multi-Ethnic Study of Atherosclerosis)","volume":"2","author":"Rosen","year":"2009","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jacc.2018.05.027","article-title":"Coronary calcium score and cardiovascular risk","volume":"72","author":"Greenland","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1161\/CIRCULATIONAHA.115.018524","article-title":"Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"133","author":"Blaha","year":"2016","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e003144","DOI":"10.1161\/JAHA.115.003144","article-title":"Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study","volume":"5","author":"Hoffmann","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1161\/CIRCULATIONAHA.119.044720","article-title":"Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: Results from the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART)","volume":"141","author":"Williams","year":"2020","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e000945","DOI":"10.1136\/openhrt-2018-000945","article-title":"A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite risk of non-calcified plaques","volume":"6","author":"Wang","year":"2019","journal-title":"Open Heart"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jacc.2020.05.084","article-title":"Spontaneous coronary artery dissection: JACC State-of-the-Art Review","volume":"76","author":"Hayes","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jcmg.2017.10.012","article-title":"Coronary artery calcification and its progression: What does it really mean?","volume":"11","author":"Mori","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1093\/eurheartj\/eht508","article-title":"Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: The Multi-Ethnic Study of Atherosclerosis","volume":"35","author":"Silverman","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart Study): Case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1161\/CIRCRESAHA.123.322002","article-title":"Air pollution, built environment, and early cardiovascular disease","volume":"132","author":"Zhang","year":"2023","journal-title":"Circ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1161\/CIRCULATIONAHA.109.901413","article-title":"Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: The MONICA, risk, genetics, archiving, and monograph (MORGAM) biomarker project","volume":"121","author":"Blankenberg","year":"2010","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.jacc.2016.11.042","article-title":"A test in context: Lipoprotein(a): Diagnosis, prognosis, controversies, and emerging therapies","volume":"69","author":"Tsimikas","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jacc.2021.11.058","article-title":"Independent association of lipoprotein(a) and coronary artery calcification with atherosclerotic cardiovascular risk","volume":"79","author":"Mehta","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e002060","DOI":"10.1136\/openhrt-2022-002060","article-title":"Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease","volume":"9","author":"Nissen","year":"2022","journal-title":"Open Heart"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1161\/CIRCULATIONAHA.118.035658","article-title":"Whole-genome sequencing to characterize monogenic and polygenic contributrions in patients hospitalized with early-onset myocardial infarction","volume":"139","author":"Khera","year":"2019","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/j.jacc.2018.07.079","article-title":"Genomic risk prediction of coronary artery disease in 480,000 adults: Implications for primary prevention","volume":"72","author":"Inouye","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102457","DOI":"10.1016\/j.cpcardiol.2024.102457","article-title":"Sex- and gender-related disparities in chest pain syndromes: The feminine mystique of chest pain","volume":"49","author":"Angeli","year":"2024","journal-title":"Curr. Probl. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:34:30Z","timestamp":1760106870000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,27]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092569"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092569","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,27]]}}}