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; on behalf of the CRE for CAD Collaborators

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 JenkinsGarry 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, on behalf of the CRE for CAD Collaborators

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

30 Citations (Scopus)

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

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

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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., ... on behalf of the CRE for CAD Collaborators (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{9d3604a802dc495fb3668848b5e97601,

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 {on behalf of the CRE for CAD Collaborators}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

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",

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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 & on behalf of the CRE for CAD Collaborators 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

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. et al.
In: Journal of the American College of Cardiology, Vol. 82, No. 13, 26.09.2023, p. 1343-1359.

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

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 - on behalf of the CRE for CAD Collaborators

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 - http://www.scopus.com/inward/record.url?scp=85170673909&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2023.06.045

DO - 10.1016/j.jacc.2023.06.045

M3 - Review 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

Keywords

Access to Document

Other files and links

NHMRC Centre of Research Excellence for Better Outcomes in Coronary Artery Disease

Cardiac rehabilitation data scoping activity – paving the way for state wide CR data collection in Victoria

NHMRC Centre for Research Excellence in Implementation for Community Chronic Disease Prevention

Cite this

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

Abstract

Keywords

Access to Document

Other files and links

Projects

NHMRC Centre of Research Excellence for Better Outcomes in Coronary Artery Disease

Cardiac rehabilitation data scoping activity – paving the way for state wide CR data collection in Victoria

NHMRC Centre for Research Excellence in Implementation for Community Chronic Disease Prevention

Cite this