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

Figtree, Gemma A.; Vernon, Stephen T.; Harmer, Jason A.; Gray, Michael P.; Arnott, Clare; Bachour, Eric; Barsha, Giannie; Brieger, David; Brown, Alex; Celermajer, David S.; Channon, Keith M.; Chew, Nicholas W.S.; Chong, James J.H.; Chow, Clara K.; Cistulli, Peter A.; Ellinor, Patrick T.; Grieve, Stuart M.; Guzik, Tomasz J.; Hagström, Emil; Jenkins, Alicia; Jennings, Garry; Keech, Anthony C.; Kott, Katharine A.; Kritharides, Leonard; Mamas, Mamas A.; Mehran, Roxana; Meikle, Peter J.; Natarajan, Pradeep; Negishi, Kazuaki; O’Sullivan, John; Patel, Sanjay; Psaltis, Peter J.; Redfern, Julie; Steg, Philippe G.; Sullivan, David R.; Sundström, Johan; Vogel, Birgit; Wilson, Andrew; Wong, Dennis; Bhatt, Deepak L.; Kovacic, Jason C.; Nicholls, Stephen J.

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.

Citation

Figtree, G. A., Vernon, S. T., Harmer, J. A., Gray, M. P., Arnott, C., Bachour, E., …Nicholls, S. J. (in press). Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors JACC State-of-the-Art Review. Journal of the American College of Cardiology, 82(13), 1343-1359. https://doi.org/10.1016/j.jacc.2023.06.045

• Journal Article Type: Article
• Acceptance Date: Jun 28, 2023
• Online Publication Date: Sep 18, 2023
• Deposit Date: Sep 25, 2023
• Publicly Available Date: Sep 25, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 82
• Issue: 13
• Pages: 1343-1359
• DOI: https://doi.org/10.1016/j.jacc.2023.06.045
• Keywords: atherosclerosis; cardiovascular risk; clinical pathway; coronary artery disease; primary prevention; secondary prevention