Improving clinical outcomes for patients with coronary artery disease despite no standard modifiable cardiovascular risk factors (SMuRF): not out of the woods yet

Graphical AbstractA secondary analysis of the CLARIFY cohort was completed in the study by Roger et al., seeking to describe the characteristics and outcomes of CLARIFY participants with stable coronary artery disease classified as without Standard Modifiable cardiovascular Risk Factors (SMuRF, or SMuRFless). SMuRFless participants represented 4.4% of the analysis cohort. In their analysis, SMuRFless participants were found to have better outcomes compared to participants with at least one SMuRF. Event rates for a composite endpoint of cardiovascular disease-related mortality or non-fatal myocardial infarction were 7.58% (95% confidence interval [CI] 7.21–7.96) in the full cohort, which was significantly lower in the SMuRFless population. Five-year all-cause mortality was 7.92% (95% CI 7.55–8.31) and 5-year risk of major adverse cardiovascular events was 9.04% (8.65–9.46) in the full cohort, both endpoints of which were significantly lower in the SMuRFless population including after adjustments.