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Acute ST-elevation myocardial infarction (STEMI) in patients without a history of standard modifiable cardiovascular risk factors for atherosclerosis occurs in about 10%-25% of patients. Generally, clinicians believe such patients fare better short and long term compared to their counterparts with standard risk factors, but this notion has not been examined adequately.
To test this hypothesis in general and by sex, Figtree et al analyzed the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) database. The authors identified patients with the first presentation of a STEMI and no history of coronary artery disease (CAD). Among 62,048 such patients, 33% were women, and 15% presented with a standard risk factor (17% men and 11% women; P < 0.001). Standard modifiable cardiovascular risk factors included hypertension (70%), elevated LDL cholesterol (> 135 mg/dL or total cholesterol > 212 mg/dL; 48%), smoking one or more cigarettes/day (33%), and diabetes (21%) — all diagnosed before their STEMI. The primary endpoint was all-cause mortality at 30 days. Secondary...