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Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry
Guillaume Roger1, Grégory Ducrocq1,2, Jules Mesnier1,2
1Cardiology Department, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France.
Insights
Patients with stable coronary artery disease (CAD) but without standard modifiable cardiovascular risk factors (SMuRFs) have significantly lower 5-year risks of cardiovascular death or myocardial infarction. This protective effect is more pronounced in women.
Area of Science:
- Cardiovascular Medicine
- Clinical Cardiology
- Epidemiology
Background:
- Patients without standard modifiable cardiovascular risk factors (SMuRFs) presenting with myocardial infarction (MI) may have different outcomes.
- Previous reports suggest higher in-hospital mortality but potentially lower long-term risk for these patients post-MI.
- The long-term prognosis of patients with stable coronary artery disease (CAD) but without SMuRFs remains less understood.
Purpose of the Study:
- To investigate the long-term clinical outcomes of patients with stable coronary artery disease (CAD) who lack standard modifiable cardiovascular risk factors (SMuRFs).
- To compare the 5-year risk of cardiovascular death or non-fatal myocardial infarction (MI) between SMuRF-less patients and those with SMuRFs.
Main Methods:
- Analysis of the CLARIFY observational cohort, including 32,703 outpatients with stable CAD from 45 countries (2009-2010).
- Comparison of baseline characteristics and 5-year clinical outcomes between patients with and without SMuRFs (diabetes, dyslipidaemia, hypertension, smoking).
- Primary outcome: composite of 5-year cardiovascular death or non-fatal MI; Secondary outcomes: 5-year all-cause mortality and MACE.
Main Results:
- Out of 22,132 patients with complete data, 977 (4.4%) were SMuRF-less.
- SMuRF-less patients exhibited a significantly lower 5-year rate of CV death or non-fatal MI (5.43% vs. 7.68%, P=0.012), all-cause mortality, and MACE.
- Clinical event rates increased progressively with the number of SMuRFs, with a particularly pronounced benefit observed in women.
Conclusions:
- Patients with stable CAD and no SMuRFs have a substantially lower 5-year risk of cardiovascular death or non-fatal MI compared to those with risk factors.
- The risk of adverse cardiovascular outcomes escalates consistently with an increasing number of SMuRFs.
- The findings highlight the importance of risk factor burden in determining long-term prognosis in stable CAD.
Background And Aims:
It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs-diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD).
Methods:
CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE-CV death, non-fatal MI, or non-fatal stroke).
Results:
Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08-7.19] vs. 7.68% [95% CI 7.30-8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women.
Conclusions:
SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.
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