On 24 April 2026, ENACT researcher Tom De Potter (VUB) presented at the ESC Preventive Cardiology Congress 2026 in Ljubljana, as part of the prestigious Young Investigator Award session.
Rethinking cardiovascular risk
Tom’s presentation focused on a striking and increasingly recognised phenomenon: patients who suffer a heart attack despite having none of the traditional cardiovascular risk factors, such as smoking, diabetes, or hypertension. These so-called “SMuRF-less” patients may appear low-risk, but in reality, they often experience worse outcomes.
His key message was clear: the absence of traditional risk factors does not mean low risk. This challenges long-standing assumptions in cardiovascular prevention and calls for a broader perspective.
The role of the environment
Using data from a large Belgian cohort spanning 9 years, the study explored how environmental and socioeconomic factors, such as air pollution and noise, may influence both the occurrence of heart attacks and survival outcomes.
In simple terms, the research showed that:
- A significant proportion of heart attack patients have no standard risk factors
- These patients face a higher risk of dying during hospitalisation
- Airport noise and unemployment status are associated with worse outcomes in heart attack patients without standard risk factors
Interestingly, the study did not find that these patients are more sensitive to short-term air pollution triggers than others, suggesting that other mechanisms may be driving their higher mortality risk.
Toward an exposomic approach
This work highlights the importance of moving beyond traditional risk models toward a more comprehensive, exposomic understanding of cardiovascular health, one that integrates environmental, social, and biological factors.
Tom’s participation in this high-level scientific session underscores both the quality of ENACT’s research and the growing recognition of the exposome in cardiovascular prevention.