Atherosclerotic cardiovascular disease patients. Six, rather than four, risk factors should define absent standard modifiable risk factors (SMuRF-less)

Background Sedentary life and obesity, according to recent ESC lipids guideline update , are risk-enhancing rather than standard modifiable risk factors (SMuRFs) for atherosclerotic cardiovascular disease (ASCVD). The SMuRFs include type 2 diabetes, hypertension, dyslipidemia, and smoking. Given the high prevalence of obesity and physical inactivity in the Middle East, including these two factors may better define SMuRF-less patients. Purpose To compare the prevalence and clinical characteristics of SMuRF-less patients using the traditional 4-RF definition versus a proposed 6-RF definition that includes obesity and physical inactivity. Methods We analyzed data from the Jordan SMuRF-less Study to examine the prevalence and clinical profiles of patients lacking six versus four modifiable risk factors. Results As shown in the Figure, among 5540 ASCVD patients, 215 (3.9%) were SMuRF-less using the 4-RF criteria. Including obesity and physical inactivity reduced the prevalence to 1.0% (N=11) among 1120 patients with 6-RF data. Compared with 4-RF SMuRF-less patients, 6-RF SMuRF-less patients were younger (50±16 vs. 56±12 years, p=0.05) and less often women (19% vs. 65%, p<0.0001). Both groups had similar prevalence of heart failure, sleep apnea, and kidney disease, and comparable rates of cardiovascular secondary prevention medications including antiplatelet, statin, renin-angiotensin system blocker, and beta-blocker. Conclusions In a large Middle Eastern ASCVD cohort, incorporating obesity and sedentary lifestyle into the SMuRF definition reduced the prevalence of SMuRF-less patients by 74% (from 3.9% to 1.0%). In regions with high prevalence of modifiable cardiovascular risk factors, ASCVD prevention strategies should target these six factors.4.6 SMURFLESS FIGUREFor image description, please refer to the figure legend and surrounding text.