Why women with no SMuRFs still have heart attacks and strokes

These are not the joyful, helpful SMuRFs of your childhood.

stroke.

Yet a significant portion of cardiac events occur in people without SMuRFs. A new study from Mass General Brigham reveals one reason why.

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The researchers found that many women at risk of a heart episode have high levels of high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, in their blood.

“Women who suffer from heart attacks and strokes yet have no standard modifiable risk factors are not identified by the risk equations doctors use in daily practice,” said Dr. Paul Ridker, a preventive cardiologist at Mass General Brigham’s Heart and Vascular Institute.

“Yet our data clearly show that apparently healthy women who are inflamed are at substantial lifetime risk,” he added. “We should be identifying these women in their 40s, at a time when they can initiate preventive care, not wait for the disease to establish itself in their 70s when it is often too late to make a real difference.”

Cardiovascular diseases (CVDs) — which include heart attack, heart failure, congenital heart defects and stroke — are responsible for over 19 million deaths worldwide each year.

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It’s unclear exactly how many people without SMuRFs suffer cardiac events. An Australian study last year of acute coronary syndrome — when blood flow to the heart is suddenly reduced — determined that 14% of patients didn’t have SMuRFs.

Mass General Brigham said that up to half of all heart attacks and strokes happen in apparently healthy people.

Research has even suggested that these SMuRF-less patients can experience worse outcomes in the short term than patients with SMuRFs.

For its part, high hsCRP levels have long been linked to an increased risk of heart problems.

The hs-CRP blood test is primarily given to those who have a 10% to 20% risk of heart disease within 10 years.

The liver naturally produces C-reactive protein. It rises significantly in response to inflammation, the body’s natural defense mechanism to combat infections and injuries.

Smoking, obesity and an inactive lifestyle can fuel chronic inflammation in the body.

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The Mass General Brigham study tracked 12,530 SMuRF-less women for 30 years.

Women who were deemed to be inflamed faced several increased risks over their lifetime. They were 77% more likely to develop coronary heart disease, 39% more likely to have a stroke and 52% more likely to suffer a major cardiovascular event.

The findings were published Friday in the European Heart Journal.

The researchers suggested that SMuRF-less but inflamed patients can reduce their risk of heart attack and stroke by 38% by taking statins, which lower cholesterol.

“While those with inflammation should aggressively initiate lifestyle and behavioral preventive efforts, statin therapy could also play an important role in helping reduce risk among these individuals,” said Ridker.