Expanding the SMuRF-less definition to include obesity and physical inactivity reduced the prevalence of SMuRF-less ASCVD patients from 3.9% (using four factors) to 1.5% (using six factors).
Cohort (n=5,540)
Does adding obesity and physical inactivity to the definition of standard modifiable risk factors reduce the prevalence of SMuRF-less patients in an ASCVD cohort?
Incorporating obesity and physical inactivity into the standard modifiable risk factors definition significantly reduces the proportion of ASCVD patients considered 'SMuRF-less', emphasizing the need to target these highly prevalent factors.
Absolute Event Rate: 1.5% vs 3.9%
Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the Middle East. Some patients sustain events in the absence of four standard modifiable risk factors (SMuRFs); hypertension (HTN), type 2 diabetes (T2D), dyslipidemia and cigarette smoking (SMuRF-less patients). We propose adding two other highly prevalent modifiable RFs; obesity and physical inactivity to the "SMuRF-less" definition. Purpose To compare the prevalence of SMuRF-less patients in a large Middle Eastern ASCVD cohort using the original definition that includes the four classical four RFs vs. the proposed definition that includes six RFs by adding obesity and physical inactivity. Methods We utilized data from the Jordan SMuRF-less Study to redefine the term "SMuRF-less" by including obesity and physical inactivity to the original four RFs and evaluated the clinical profiles of the SMuRF-less patients compared with those who have RF. Results The analysis involved 5540 ASCVD patients (mean age 57.5±11.6 years, and 1333 (24.1%) were women). HTN was present in 3197 (57.7%), dyslipidemia in 4053 (73.2%), T2D in 2840 (51.3%), and cigarette smoking in 2350 (42.4%) patients. Only 214 (3.9%) of those patients were SMuRF-less with none of the original four RFs. Of the whole group, there were 1121 patients with available body mass index and physical activity data. Of those, 42.8% were obese and 68.7% were physically inactive. Only 17 (1.5%) patients were "SMuRF-less" using the six RFs. Picture depicts the number of RFs in this cohort. SMuRF-less patients were younger than those with ≥ 1 SMuRF (50.5±4 years vs. 57.9±8 years, p=0.0001), more likely to be women (64.7% vs. 42.2%, p=0.05), and less likely to have heart failure and chronic renal disease. They also had lower mean LDL-C (91 mg/dl vs. 102 mg/dl, p=0.001) and HDL-C (30.3 mg/dl vs. 42.4 mg/dl). Conclusions We redefined the term "SMuRF-less" to include obesity and physical inactivity in addition to the original RFs, the prevalence of "SMuRF-less" was reduced from about 4% to 1.5%. SMuRF-less patients had more favorable clinical profile than those with SMuRFs. In regions with high prevalence of cardiovascular RFs, such as the Middle East, prioritizing strategies to control the ASCVD epidemic should heavily rely on controlling these six RFs, rather than searching for rare, nontraditional RFs.6-SMURFLESS
Hammoudeh et al. (Sat,) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=5,540). Six-factor SMuRF-less definition (adding obesity and physical inactivity) vs. Original four-factor SMuRF-less definition was evaluated on Prevalence of SMuRF-less patients. Expanding the SMuRF-less definition to include obesity and physical inactivity reduced the prevalence of SMuRF-less ASCVD patients from 3.9% (using four factors) to 1.5% (using six factors).