ST-Elevation Myocardial Infarction in Young Patients Without Standard Modifiable Risk Factors: A Challenge but Also an Opportunity.

Despite the tremendous progress in reducing the incidence of coronary artery disease (CAD) over the past 3 to 4 decades, the prevalence of cardiovascular morbidity and mortality, especially in the Western world, remains high. 1 Vaduganathan M Mensah GA Turco JV Fuster V Roth GA The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol. 2022; 80: 2361-2371 Crossref PubMed Scopus (56) Google Scholar One of the main urgent manifestations of CAD is the sudden onset of an acute coronary syndrome with ST-elevation myocardial infarction (STEMI). In addition to establishing early reperfusion in the acute phase, clinicians must address the optimal treatment of patients who have experienced a STEMI, which traditionally consists of management of the standard modifiable risk factors (SMuRFs) such as diabetes, hypertension, smoking, and hyperlipidemia. Although this paradigm is no different from the treatment of people with chronic CAD at risk for myocardial infarction and other cardiovascular events, about 10% to 15% of patients presenting with a STEMI have no SMuRFs and have been referred to as SMuRF-less patients. Unfortunately, these patients seem to have worse adverse cardiovascular and noncardiovascular outcomes than patients with 1 or more SMuRFs. 2 Figtree GA Vernon ST Hadziosmanovic N Sundström J Alfredsson J Arnott C Delatour V Leósdóttir M Hagström E Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data [published correction appears in Lancet 2021;397:1182]. Lancet. 2021; 397: 1085-1094 Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar ,3 Kong G Chin YH Chong B Goh RSJ Lim OZH Ng CH Muthiah M Foo R Vernon ST Loh PH Chan MY Chew NWS Figtree GA Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: results from a global meta-analysis of 1,285,722 patients. Int J Cardiol. 2023; 371: 432-440 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Developing novel approaches to nontraditional risk factors and presentations of CAD is a challenge but is also an important opportunity.