Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review

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

doi:10.1016/j.jacc.2023.06.045

Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review

Gemma A. Figtree
, Stephen T. Vernon
, Jason A. Harmer
, Michael P. Gray
, Clare Arnott
, Eric Bachour
, Giannie Barsha
, David Brieger
, Alex Brown
, David S. Celermajer
, Keith M. Channon
, Nicholas W.S. Chew
, James J.H. Chong
, Clara K. Chow
, Peter A. Cistulli
, Patrick T. Ellinor
, Stuart M. Grieve
, Tomasz J. Guzik
, Emil Hagström
, Alicia Jenkins

Garry Jennings, Anthony C. Keech, Katharine A. Kott, Leonard Kritharides, Mamas A. Mamas, Roxana Mehran, Peter J. Meikle, Pradeep Natarajan, Kazuaki Negishi, John O'Sullivan, Sanjay Patel, Peter J. Psaltis, Julie Redfern, Philippe G. Steg, David R. Sullivan, Johan Sundström, Birgit Vogel, Andrew Wilson, Dennis Wong, Deepak L. Bhatt, Jason C. Kovacic, Stephen J. Nicholls, CRE for CAD Collaborators, Craig P. Coorey, et al.

Western Sydney University

The University of Sydney
Kolling Institute of Medical Research
Royal North Shore Hospital
University of New South Wales
Royal Prince Alfred Hospital
Agile Group Switzerland AG
Concord Repatriation General Hospital
Australian National University
Telethon Kids Institute
University of Oxford
National University Health System
Westmead Hospital
Broad Institute
Massachusetts General Hospital
University of Edinburgh
Jagiellonian University Medical College
Uppsala University
Baker Heart and Diabetes Institute
Keele University
University Hospitals of North Midlands NHS Trust
Icahn School of Medicine at Mount Sinai
Harvard University
Nepean Hospital
South Australian Health And Medical Research Institute
University of Adelaide
Royal Adelaide Hospital
Université Paris Cité
Monash University
Monash Health
Mount Sinai Hospital Medical Center
Victor Chang Cardiac Research Institute

Research output: Contribution to journal › Article › peer-review

86 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	1343-1359
Number of pages	17
Journal	Journal of the American College of Cardiology
Volume	82
Issue number	13
DOIs	https://doi.org/10.1016/j.jacc.2023.06.045
Publication status	Published - 26 Sept 2023

Open Access - Access Right Statement

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

atherosclerosis
cardiovascular risk
clinical pathway
coronary artery disease
primary prevention
secondary prevention

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10.1016/j.jacc.2023.06.045Licence: CC BY-NC-ND

full textFinal published version, 1.65 MBLicence: CC BY-NC-ND

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Figtree, G. A., Vernon, S. T., Harmer, J. A., Gray, M. P., Arnott, C., Bachour, E., Barsha, G., Brieger, D., Brown, A., Celermajer, D. S., Channon, K. M., Chew, N. W. S., Chong, J. J. H., Chow, C. K., Cistulli, P. A., Ellinor, P. T., Grieve, S. M., Guzik, T. J., Hagström, E., ... et al. (2023). 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

@article{31f5ca5cf1ce48f7bd0dcf24ce4fcac1,

title = "Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review",

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.",

keywords = "atherosclerosis, cardiovascular risk, clinical pathway, coronary artery disease, primary prevention, secondary prevention",

author = "Figtree, \{Gemma A.\} and Vernon, \{Stephen T.\} and Harmer, \{Jason A.\} and Gray, \{Michael P.\} and Clare Arnott and Eric Bachour and Giannie Barsha and David Brieger and Alex Brown and Celermajer, \{David S.\} and Channon, \{Keith M.\} and Chew, \{Nicholas W.S.\} and Chong, \{James J.H.\} and Chow, \{Clara K.\} and Cistulli, \{Peter A.\} and Ellinor, \{Patrick T.\} and Grieve, \{Stuart M.\} and Guzik, \{Tomasz J.\} and Emil Hagstr{\"o}m and Alicia Jenkins and Garry Jennings and Keech, \{Anthony C.\} and Kott, \{Katharine A.\} and Leonard Kritharides and Mamas, \{Mamas A.\} and Roxana Mehran and Meikle, \{Peter J.\} and Pradeep Natarajan and Kazuaki Negishi and John O'Sullivan and Sanjay Patel and Psaltis, \{Peter J.\} and Julie Redfern and Steg, \{Philippe G.\} and Sullivan, \{David R.\} and Johan Sundstr{\"o}m and Birgit Vogel and Andrew Wilson and Dennis Wong and Bhatt, \{Deepak L.\} and Kovacic, \{Jason C.\} and Nicholls, \{Stephen J.\} and \{CRE for CAD Collaborators\} and Coorey, \{Craig P.\} and \{et al.\}",

year = "2023",

month = sep,

day = "26",

doi = "10.1016/j.jacc.2023.06.045",

language = "English",

volume = "82",

pages = "1343--1359",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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number = "13",

}

Figtree, GA, Vernon, ST, Harmer, JA, Gray, MP, Arnott, C, Bachour, E, Barsha, G, Brieger, D, Brown, A, Celermajer, DS, Channon, KM, Chew, NWS, Chong, JJH, Chow, CK, Cistulli, PA, Ellinor, PT, Grieve, SM, Guzik, TJ, Hagström, E, Jenkins, A, Jennings, G, Keech, AC, Kott, KA, Kritharides, L, Mamas, MA, Mehran, R, Meikle, PJ, Natarajan, P, Negishi, K, O'Sullivan, J, Patel, S, Psaltis, PJ, Redfern, J, Steg, PG, Sullivan, DR, Sundström, J, Vogel, B, Wilson, A, Wong, D, Bhatt, DL, Kovacic, JC, Nicholls, SJ, CRE for CAD Collaborators, , Coorey, CP & et al. 2023, '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, vol. 82, no. 13, pp. 1343-1359. https://doi.org/10.1016/j.jacc.2023.06.045

TY - JOUR

T1 - Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors

T2 - JACC state-of-the-art review

AU - Figtree, Gemma A.

AU - Vernon, Stephen T.

AU - Harmer, Jason A.

AU - Gray, Michael P.

AU - Arnott, Clare

AU - Bachour, Eric

AU - Barsha, Giannie

AU - Brieger, David

AU - Brown, Alex

AU - Celermajer, David S.

AU - Channon, Keith M.

AU - Chew, Nicholas W.S.

AU - Chong, James J.H.

AU - Chow, Clara K.

AU - Cistulli, Peter A.

AU - Ellinor, Patrick T.

AU - Grieve, Stuart M.

AU - Guzik, Tomasz J.

AU - Hagström, Emil

AU - Jenkins, Alicia

AU - Jennings, Garry

AU - Keech, Anthony C.

AU - Kott, Katharine A.

AU - Kritharides, Leonard

AU - Mamas, Mamas A.

AU - Mehran, Roxana

AU - Meikle, Peter J.

AU - Natarajan, Pradeep

AU - Negishi, Kazuaki

AU - O'Sullivan, John

AU - Patel, Sanjay

AU - Psaltis, Peter J.

AU - Redfern, Julie

AU - Steg, Philippe G.

AU - Sullivan, David R.

AU - Sundström, Johan

AU - Vogel, Birgit

AU - Wilson, Andrew

AU - Wong, Dennis

AU - Bhatt, Deepak L.

AU - Kovacic, Jason C.

AU - Nicholls, Stephen J.

AU - CRE for CAD Collaborators,

AU - Coorey, Craig P.

AU - et al.,

PY - 2023/9/26

Y1 - 2023/9/26

N2 - 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.

AB - 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.

KW - atherosclerosis

KW - cardiovascular risk

KW - clinical pathway

KW - coronary artery disease

KW - primary prevention

KW - secondary prevention

UR - https://www.scopus.com/pages/publications/85170673909

U2 - 10.1016/j.jacc.2023.06.045

DO - 10.1016/j.jacc.2023.06.045

M3 - Article

C2 - 37730292

AN - SCOPUS:85170673909

SN - 0735-1097

VL - 82

SP - 1343

EP - 1359

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 13

ER -

Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review

Abstract

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Keywords

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