Absence of Documented Standard Modifiable Cardiovascular Risk Factors Among Catheterized Admissions in Bangladesh: Frequency and Coronary Angiographic Phenotype in a 20‐Year Registry Study
- 1Department of Cardiology Ibrahim Cardiac Hospital & Research Institute Dhaka Bangladesh
Abstract
Background and Aims: Coronary artery disease may occur without standard modifiable cardiovascular risk factors (SMuRFs), but the frequency and angiographic phenotype of such presentations in South Asian catheterization cohorts remain uncertain. We estimated registry‐defined SMuRF‐less frequency, tested alternative dyslipidaemia definitions, and compared angiographic phenotypes by SMuRF status.
Methods: We conducted a retrospective, single‐centre, registry‐based cross‐sectional analysis of 51,864 admissions with matched catheterization records at a Bangladeshi tertiary cardiac centre from 2005 to 2024. Admissions were classified as SMuRF‐less when no qualifying hypertension, diabetes, smoking, or dyslipidaemia was documented or identified; dyslipidaemia reflected a documented diagnosis or qualifying lipid measurement. Documented‐only and statin‐inclusive definitions were sensitivity analyses. We calculated unadjusted prevalence ratios (PRs) and 95% confidence intervals (CIs).
Results: Under the primary definition, 3172 admissions (6.1%) were SMuRF‐less, compared with 6.5% under the documented‐only definition and 1.6% under the statin‐inclusive definition. Among admissions with a classifiable angiographic phenotype, SMuRF‐less admissions more frequently had normal coronary arteries (24.9% vs. 10.7%; PR, 2.34; 95% CI, 2.18–2.50) and less frequently had obstructive coronary artery disease (56.6% vs. 71.2%; PR, 0.79; 95% CI, 0.77–0.82). Among admissions with obstructive disease, multivessel disease was less frequent (49.6% vs. 57.8%; PR, 0.86; 95% CI, 0.82–0.90), whereas recorded intracoronary thrombus was more frequent (5.3% vs. 3.2%; PR, 1.65; 95% CI, 1.33–2.04). Of 6635 ST‐elevation myocardial infarction admissions, 355 (5.4%) were SMuRF‐less; 318 (89.6%) had obstructive disease.
Conclusion: Registry‐defined SMuRF‐less admissions, reflecting absence of documented qualifying factors rather than prospectively verified biological absence, were uncommon, and their estimated frequency depended on risk‐factor ascertainment. Although their recorded angiographic burden was generally lower, obstructive disease remained common, particularly in ST‐elevation myocardial infarction. The absence of documented SMuRFs should not provide clinical reassurance. Prospective patient‐level studies with standardized risk‐factor assessment and longitudinal follow‐up are needed.
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BibTeX
@article{hasan2026absence,
title = {{Absence of Documented Standard Modifiable Cardiovascular Risk Factors Among Catheterized Admissions in Bangladesh: Frequency and Coronary Angiographic Phenotype in a 20‐Year Registry Study}},
author = {Md Mahbub Hasan and M. Maksumul Haq and CM Shaheen Kabir and Mashhud Zia Chowdhury and Saidur Rahman Khan and Md. Hasanur Rahman and Sahela Nasrin and Isha Abdullah Ali and Khondoker Md Ferdoush Siraj and Arifur Rahman and Sayem Bin Latif},
journal = {Health Science Reports},
year = {2026},
month = nov,
doi = {10.1002/hsr2.73466},
url = {https://doi.org/10.1002/hsr2.73466},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Absence of Documented Standard Modifiable Cardiovascular Risk Factors Among Catheterized Admissions in Bangladesh: Frequency and Coronary Angiographic Phenotype in a 20‐Year Registry Study
AU - Md Mahbub Hasan
AU - M. Maksumul Haq
AU - CM Shaheen Kabir
AU - Mashhud Zia Chowdhury
AU - Saidur Rahman Khan
AU - Md. Hasanur Rahman
AU - Sahela Nasrin
AU - Isha Abdullah Ali
AU - Khondoker Md Ferdoush Siraj
AU - Arifur Rahman
AU - Sayem Bin Latif
PY - 2026
DA - 2026/11/04
JO - Health Science Reports
DO - 10.1002/hsr2.73466
UR - https://doi.org/10.1002/hsr2.73466
AB - Background and Aims: Coronary artery disease may occur without standard modifiable cardiovascular risk factors (SMuRFs), but the frequency and angiographic phenotype of such presentations in South Asian catheterization cohorts remain uncertain. We estimated registry‐defined SMuRF‐less frequency, tested alternative dyslipidaemia definitions, and compared angiographic phenotypes by SMuRF status. Methods: We conducted a retrospective, single‐centre, registry‐based cross‐sectional analysis of 51,864 admissions with matched catheterization records at a Bangladeshi tertiary cardiac centre from 2005 to 2024. Admissions were classified as SMuRF‐less when no qualifying hypertension, diabetes, smoking, or dyslipidaemia was documented or identified; dyslipidaemia reflected a documented diagnosis or qualifying lipid measurement. Documented‐only and statin‐inclusive definitions were sensitivity analyses. We calculated unadjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Under the primary definition, 3172 admissions (6.1%) were SMuRF‐less, compared with 6.5% under the documented‐only definition and 1.6% under the statin‐inclusive definition. Among admissions with a classifiable angiographic phenotype, SMuRF‐less admissions more frequently had normal coronary arteries (24.9% vs. 10.7%; PR, 2.34; 95% CI, 2.18–2.50) and less frequently had obstructive coronary artery disease (56.6% vs. 71.2%; PR, 0.79; 95% CI, 0.77–0.82). Among admissions with obstructive disease, multivessel disease was less frequent (49.6% vs. 57.8%; PR, 0.86; 95% CI, 0.82–0.90), whereas recorded intracoronary thrombus was more frequent (5.3% vs. 3.2%; PR, 1.65; 95% CI, 1.33–2.04). Of 6635 ST‐elevation myocardial infarction admissions, 355 (5.4%) were SMuRF‐less; 318 (89.6%) had obstructive disease. Conclusion: Registry‐defined SMuRF‐less admissions, reflecting absence of documented qualifying factors rather than prospectively verified biological absence, were uncommon, and their estimated frequency depended on risk‐factor ascertainment. Although their recorded angiographic burden was generally lower, obstructive disease remained common, particularly in ST‐elevation myocardial infarction. The absence of documented SMuRFs should not provide clinical reassurance. Prospective patient‐level studies with standardized risk‐factor assessment and longitudinal follow‐up are needed.
SN - 2398-8835
ER -