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

CRE for CAD Collaborators, 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, Julie Redfern

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

12 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1343-1359
Number of pages17
JournalJournal of the American College of Cardiology
Volume82
Issue number13
DOIs
Publication statusPublished - 26 Sept 2023
Externally publishedYes

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