A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors (SMuRF-less). There is scarcity of studies that address this issue in the Middle Eastern population.

Atherosclerotic coronary artery disease (ASCAD) claims millions of lives annually on a global level and is the leading cause of death in the Middle East. There are four standard modifiable cardiovascular risk factors (SMuRFs): hypertension, type 2 diabetes mellitus, dyslipidemia, and smoking. These are very common in the Middle East and are crucial to be screened for and addressed in an affective manner.

However, an increasing proportion of patients with ASCVD have none of these individual factors (SMuRF-less). Globally, this proportion comprises 11.6% of individuals with stable coronary disease and heart attack. No prior study has addressed the issue of the prevalence of SMuRF-less patients among the whole population of individuals with ASCVD in the Middle East.

Inclusion Criteria:

• A diagnosis of atherosclerotic cardiovascular disease (ASCVD).
• Ability to fill the clinical form that evaluates the presence or absence of cardiovascular risk factors including the 4 SMuRFs.

Exclusion Criteria:

• Atherosclerotic cardiovascular disease diagnosed before the age of 18 years.
• Inability to give detailed history of prespecified risk factors.

1. Adults (18 years of age and older) with ASCVD.

2. ASCVD includes:

   1. Coronary heart disease
   2. stroke
   3. peripheral artery disease.

Will invite physicians to recruit 5000 individuals with ASCVD starting 1-1-2024. Once the team is gathered will share the clinical form with the all participating physicians.