ArticleJournal of the American Heart Association2023
Mortality in Patients Hospitalized With Acute Myocardial Infarction Without Standard Modifiable Risk Factors: The ARIC Study Community Surveillance.
Article in Journal of the American Heart Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 23 citations in OpenAlex.
- Association of the pan-immune-inflammation value with 60-day in-hospital mortality in critically ill patients with acute myocardial infarction: evidence from the MIMIC-IV database.BMC cardiovascular disorders · 2026Article
- The paradox of SMURF-less outcomes and its implication for diabetes.European heart journal. Quality of care & clinical outcomes · 2026Article
- Risk Without Recognition: Anticipating the Rise of SMuRF-Less Myocardial Infarction.JACC. Asia · 2026Article
- Metabolic Syndrome in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease: A High Burden Driven by Cumulative Risk Factors.Journal of cardiovascular development and disease · 2026Article
- Non-HDL Cholesterol and Residual Cardiometabolic Risk in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease.Healthcare (Basel, Switzerland) · 2026Article
- Redefining atherosclerotic cardiovascular disease patients with no standard modifiable risk factors "SMuRF-less": six rather than four risk factors. Analysis from the Jordan SMuRF-less Study.Frontiers in cardiovascular medicine · 2026Article
- A Cross-Sectional Analytical Study: Prevalence and Clinical Profile of Metabolic Syndrome Among Middle Eastern, Mainly Jordanians, Cohort Presented with Atherosclerotic Cardiovascular Disease.Vascular health and risk management · 2026Observational
- Nano-functionalized probiotic treats atherosclerosis via inhibiting intestinal microbiota-TMA-TMAO axis.Nature communications · 2025Article
- Standard modifiable cardiovascular risk factors and coronary artery disease severity in adults with myocardial infarction ≤ 35.American journal of preventive cardiology · 2025Article
- Very High Prevalence of Nonoptimally Controlled Traditional Risk Factors at the Onset of Cardiovascular Disease.Journal of the American College of Cardiology · 2025Article
- Turning evidence into action: the real challenge of guideline-directed medical therapy in acute myocardial infarction.The Korean journal of internal medicine · 2025Article
- Acute coronary syndromes: mechanisms, challenges, and new opportunities.European heart journal · 2025Review
- Correlation of greyzone fibrosis compared to troponin T and late gadolinium enhancement with survival and ejection fraction in patients after acute myocardial infarction.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- Absence of Standard Modifiable Risk Factors in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease. The Jordan Absence of Standard Modifiable Risk Factors (SMuRF-Less) Study.Vascular health and risk management · 2025Article
- Article
- Association of SMuRFs with cardiovascular risk factors, disease burden, and pharmacological management in Middle Eastern patients with ASCVD and a family history of premature CVD.Frontiers in cardiovascular medicine · 2025Article
- Evaluating Long-Term Outcomes in STEMI Patients with New Left Bundle Branch Block: The Impact of Modifiable Risk Factors.Journal of personalized medicine · 2024Article
- Prevalence, predictors, and in-hospital outcomes of ST-elevation myocardial infarction among young adults without traditional cardiovascular risk factors in the United States.American heart journal plus : cardiology research and practice · 2024Article
- Prevalence and outcomes of patients with SMuRF-less acute coronary syndrome undergoing percutaneous coronary intervention.Open heart · 2024Article
- Association of Lipoprotein (a) and Standard Modifiable Cardiovascular Risk Factors With Incident Myocardial Infarction: The Mass General Brigham Lp(a) Registry.Journal of the American Heart Association · 2024Article
Corrections and comments
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Authors and funding
14 authors at 8 institutions in 1 country.
Funding
Abstract
Background Prevention strategies targeting standard modifiable cardiovascular risk factors (SMuRFs; diabetes, hypertension, smoking, hypercholesterolemia) are critical to improving cardiovascular disease outcomes. However, acute myocardial infarction (AMI) among individuals who lack 1 or more SMuRFs is not uncommon. Moreover, the clinical characteristics and prognosis of SMuRFless individuals are not well characterized. Methods and Results We analyzed AMI hospitalizations from 2000 to 2014 captured by the ARIC (Atherosclerosis Risk in Community) study community surveillance. AMI was classified by physician review using a validated algorithm. Clinical data, medications, and procedures were abstracted from the medical record. Main study outcomes included short- and long-term mortality within 28 days and 1 year of AMI hospitalization. Between 2000 and 2014, a total of 742 (3.6%) of 20 569 patients with AMI were identified with no documented SMuRFs. Patients without SMuRFs were less likely to receive aspirin, nonaspirin antiplatelet therapy, or beta blockers and less often underwent angiography and revascularization. Compared with those with one or more SMuRFs, patients without SMuRFs had significantly higher 28-day (odds ratio, 3.23 [95% CI, 1.78-5.88]) and 1-year (hazard ratio, 2.09 [95% CI, 1.29-3.37]) adjusted mortality. When examined across 5-year intervals from 2000 to 2014, the incidence of 28-day mortality significantly increased for patients without SMuRFs (7% to 15% to 27%), whereas it declined for those with 1 or more SMuRFs (7% to 5% to 5%). Conclusions Individuals without SMuRFs presenting with AMI have an increased risk of all-cause mortality with an overall lower prescription rate for guideline-directed medical therapy. These findings highlight the need for evidence-based pharmacotherapy during hospitalization and the need to discover new markers and mechanisms for early risk identification in this population.
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