Figtree GA, Vernon ST, Hadziosmanovic N, et al. - Prevention strategies targeting standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, hypercholesterolaemia, and smoking) are vital in cardiovascular disease, but myocardial infarction is not uncommon in the absence of SMuRFs. Researchers reported on the outcomes of those presenting with ST-elevation myocardial infarction (STEMI) without SMuRFs. Using data from the Swedish myocardial infarction registry SWEDEHEART, they retrospectively assessed adult patients with first-presentation STEMI. Among 62,048 patients with STEMI reported between January 1, 2005 and May 25, 2018, there were 9,228 (14.9%) who had no SMuRFs at diagnostic thresholds. A comparable rate of percutaneous coronary intervention was seen in SMuRF-less patients vs those with at least one, but at discharge they were significantly less likely to be taking statins, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockade (ARB), or β-blockers. All-cause mortality was significantly higher in SMuRF-less patients by 30 days after presentation, with SMuRF-less women having the highest 30-day mortality, followed by women with SMuRFs, SMuRF-less men, and men with SMuRFs. All-cause mortality was still higher in the SMuRF-less group for more than 8 years in men and up to 12 years in women. Findings revealed significantly higher risk of all-cause mortality in those with STEMI and no SMuRFs vs those with at least one; this was especially evident in women. Following adjustment for use of guideline-indicated treatments, the higher early mortality rates were lower, underscoring how evidence-based pharmacotherapy is needed immediately post infarct, even if the risk is perceived as low.