Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
Int J Cardiol. 2023 Jan 15;371:432-440. doi: 10.1016/j.ijcard.2022.09.062. Epub 2022 Sep 27.
BACKGROUND: Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes, hyperlipidemia, hypertension, and smoking, are used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. METHODS: Embase, Medline and Pubmed were searched for studies comparing SMuRF-less and SMuRF patients with first presentation of ACS. We conducted single-arm analyses to determine the proportion of SMuRF-less patients in the ACS cohort, and compared the clinical presentation and outcomes of these patients. RESULTS: Of 1,285,722 patients from 15 studies, 11.56% were SMuRF-less. A total of 7.44% of non-ST-segment-elevation ACS patients and 12.87% of ST-segment-elevation myocardial infarction (STEMI) patients were SMuRF-less. The proportion of SMuRF-less patients presenting with STEMI (60.71%) tended to be higher than those with SMuRFs (49.21%). Despite lower body mass index and fewer comorbidities such as chronic kidney disease, peripheral arterial disease, stroke and heart failure, SMuRF-less patients had increased in-hospital mortality (RR:1.57, 95%CI:1.38 to 1.80) and cardiogenic shock (RR:1.39, 95%CI:1.18 to 1.65), but lower risk of heart failure (RR:0.91, 95%CI:0.83 to 0.99). On discharge, SMuRF-less patients were prescribed less statins (RR:0.93, 95%CI:0.91 to 0.95), beta-blockers (RR:0.94, 95%CI:0.92 to 0.96), P2Y12 inhibitors (RR: 0.98, 95%CI: 0.96 to 0.99), and angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker (RR:0.92, 95%CI:0.75 to 0.91). CONCLUSION: In this study level meta-analysis, SMuRF-less ACS patients demonstrate higher mortality compared with patients with at least one traditional atherosclerotic risk factor. Underuse of guideline-directed medical therapy amongst SMuRF-less patients is concerning. Unraveling novel risk factors amongst SMuRF-less individuals is the next important step. SUMMARY: Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes mellitus, hyperlipidemia, hypertension, and smoking, are often used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. Of 1,285,722 ACS patients, 11.56% were SMuRF-less. Despite lower body mass index and fewer comorbidities, SMuRF-less patients had increased in-hospital mortality and cardiogenic shock. However, despite worse outcomes, SMuRF-less patients were prescribed less guideline-directed medical therapies on discharge.
背景：标准可修正心血管风险因素（SMuRF）包括糖尿病、高血脂、高血压和吸烟，常用于急性冠状动脉综合征（ACS）的风险分层。最近的研究表明，SMuRF 缺乏的 ACS 患者比例不断增加。
方法：在 Embase、Medline 和 Pubmed 上搜索比较 SMuRF 缺乏和 SMuRF 患者首次出现 ACS 的研究。我们进行了单臂分析，以确定 ACS 队列中 SMuRF 缺乏患者的比例，并比较这些患者的临床表现和结局。
结果：在 15 项研究的 1285722 名患者中，11.56%为 SMuRF 缺乏。非 ST 段抬高型 ACS 患者中 SMuRF 缺乏的比例为 7.44%，ST 段抬高型心肌梗死（STEMI）患者为 12.87%。STEMI 患者中 SMuRF 缺乏的比例（60.71%）往往高于有 SMuRF 的患者（49.21%）。尽管 SMuRF 缺乏的患者体重指数较低，合并症较少，如慢性肾脏病、外周动脉疾病、中风和心力衰竭，但住院死亡率（RR：1.57，95%CI：1.38 至 1.80）和心原性休克（RR：1.39，95%CI：1.18 至 1.65）更高，而心力衰竭风险（RR：0.91，95%CI：0.83 至 0.99）较低。出院时，SMuRF 缺乏的患者接受他汀类药物（RR：0.93，95%CI：0.91 至 0.95）、β受体阻滞剂（RR：0.94，95%CI：0.92 至 0.96）、P2Y12 抑制剂（RR：0.98，95%CI：0.96 至 0.99）和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（RR：0.92，95%CI：0.75 至 0.91）的治疗比例较低。
结论：在本研究的荟萃分析中，SMuRF 缺乏的 ACS 患者与至少有一个传统动脉粥样硬化危险因素的患者相比，死亡率更高。SMuRF 缺乏的患者指南指导的药物治疗使用率较低令人担忧。在 SMuRF 缺乏的个体中，揭示新的危险因素是下一步的重要步骤。
摘要：标准可修正心血管风险因素（SMuRF）包括糖尿病、高血脂、高血压和吸烟，常用于急性冠状动脉综合征（ACS）的风险分层。最近的研究表明，SMuRF 缺乏的 ACS 患者比例不断增加。在 1285722 例 ACS 患者中，有 11.56%为 SMuRF 缺乏。尽管体重指数较低且合并症较少，SMuRF 缺乏的患者住院死亡率和心原性休克发生率更高。然而，尽管预后较差，SMuRF 缺乏的患者出院时接受的指南指导的药物治疗较少。
Sci China Life Sci. 2025-6-23
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