ST-Elevation Myocardial Infarction in Young Patients Without Standard Modifiable Risk Factors: A Challenge but Also an Opportunity

Despite the tremendous progress in reducing the incidence of coronary artery disease (CAD) over the past 3 to 4 decades, the prevalence of cardiovascular morbidity and mortality, especially in the Western world, remains high.1 One of the main urgent manifestations of CAD is the sudden onset of an acute coronary syndrome with ST-elevation myocardial infarction (STEMI). Outcome-based studies have failed to determine whether additional therapy in the acute or subacute phase can reduce the incidence of these adverse events. [...]the role of targeting other risk factors, particularly, related to oxidant stress and inflammatory signaling remains incompletely explored.8,9 Such nontraditional risk factors, including HIV, systemic lupus erythematosus, obstructive sleep apnea, lipoprotein(a) and inflammatory biomarkers, have been proposed but the data are limited.10 Observational studies such as those presented by Kelly et al4 are important but often pose as many questions as they answer. The SMuRF-less patients are an ideal population to study whether goal-directed medical therapy should be given only to people who have risk factors or to everybody who had a heart attack or a cardiovascular event.