SMuRF-Less but Inflamed: Residual Cardiovascular Risk Beyond Traditional Risk Factors

During the ESC 2025 congress, Dr. Paul Ridker and Dr. C. Michael Gibson discussed new insights into the “SMuRF-less” patient population—individuals who present with acute myocardial infarction despite having no standard modifiable risk factors (SMuRFs), such as hypertension, diabetes, dyslipidemia, or smoking.

The conversation focused on findings showing that systemic inflammation represents a critical, modifiable driver of cardiovascular risk in these patients. Ridker emphasized that although SMuRF-less patients might appear “low risk” based on conventional criteria, inflammatory biomarkers identify a subgroup with a disproportionately high residual risk of adverse cardiovascular outcomes.

Dr. Gibson noted that this recognition shifts the paradigm: instead of focusing solely on traditional risk factor modification, clinicians must consider inflammation as an actionable therapeutic target. Ridker highlighted the importance of anti-inflammatory strategies, such as IL-1β and colchicine-based therapies, in reducing cardiovascular events, underscoring that inflammation is no longer a bystander but a central element of cardiovascular pathophysiology.

This dialogue reinforces the need for broader risk assessment models that integrate inflammatory markers, aiming to identify vulnerable patients earlier and expand preventive strategies beyond lipid and blood pressure management.

Credits: https://clinicaltrialresults.org/