Absence of Standard Modifiable Risk Factors in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease. The Jordan Absence of Standard Modifiable Risk Factors (SMuRF-Less) Study.

8 , 9 A recent study found that almost 1 in 5 patients were SMuRF-less, and documented the presence of temporal and dynamic changes in the prevalence of SMuRF-less patients with time, with an increasing trend in the prevalence of this unique group over a period of approximately two decades from 14% in 1999 to 23% in 2017. 10 Prognosis of SMuRF-less individuals was reported to be worse, 11 similar or more favorable than that in SMuRFs patients. 12–14 The significant heterogeneity of SMuRF-less populations has made it difficult to have guidelines.

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Of the social determinants of health studied, a higher level of education with borderline significance and lack of health insurance were more prevalent in SMuRF-less patients.

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