Global Registry Demonstrates a Surprisingly High Risk of Cardiovascular Events in Stable Patients With a History of Atherothrombotic Disease13 March 2006
Outpatients with stable atherothrombosis have a surprisingly high risk of death or major cardiovascular illness, according to new 1-year follow up data from the first outpatient registry to characterise the real-world burden of atherothrombotic disease worldwide (REACH). The study was presented today at the American College of Cardiology's 55th Scientific Session. Within a year, around one in eight patients, on average, will die, have a heart attack or stroke, or be hospitalized for a complication arising from atherothrombosis - clogged arteries in the heart, brain, or legs-and the risk is even greater for patients with widespread vascular disease.
Overall, investigators observed a major adverse cardiovascular event (MACE) rate of 13 percent at one-year follow-up. Strikingly however, patients with peripheral arterial disease-clogged arteries in the legs or abdominal organs-were at substantially higher risk, with a one-year MACE rate of 22 percent. In addition, there was a stepwise increase in risk in those with widespread atherothrombotic disease. In patients with atherothrombotic disease in one location only, the MACE rate was 13 percent, whereas in those with disease in three locations, the MACE risk climbed to 28 percent.
For patients without a history of coronary, cerebrovascular or peripheral arterial disease, but who have at least 3 risk factors for developing these conditions (such as diabetes, high blood pressure, high cholesterol and smoking), around 5 percent had a major event or were hospitalized within 1 year.
"I find these event rates to be high, given that we are dealing with a stable outpatient population treated with contemporary therapy," said Dr Gabriel Steg, professor of cardiology at Hopital Bichat-Claude Bernard, Paris, on behalf of the REACH Registry's Scientific Council. "The REACH data shows that it is critical that we stop viewing atherothrombosis as a disease of a specific medical specialty - cardiology, neurology, or vascular disease - instead we must view it as a 'global' disease," Dr. Steg said.
Objectives and scope of REACH
The overall aim of the REACH registry is to improve the assessment and management of stroke, heart attack and associated risk factors for atherothrombosis. It is the largest and most geographically extensive global registry of patients at risk of atherothrombosis, recruiting 68,000 patients in 44 countries, covering six regions - Latin America, Asia, the Middle East, Australia, Europe and North America - and involving over 5,000 physician investigators.
The REACH Registry includes a broad spectrum of patients with atherothrombosis - documenting the health status and treatment of people at risk of atherothrombosis; monitoring how they are affected; and measuring the burden of the disease. Patients included in the REACH Registry either have several of the risk factors that can lead to atherothrombosis, such as, high cholesterol, high blood pressure, smoking, and diabetes, or have a previous history of heart attack, stroke or PAD. Participation in the REACH Registry is strictly voluntary.
In addition, the REACH registry is based in a real-life setting and seeks to increase overall understanding of atherothrombotic disease across several medical specialities (cardiology, neurology, internal medicine, vascular medicine and office-based primary care physicians), which allows for a more thorough assessment of the real-world burden of the disease.
The underlying cause of heart attack, stroke and peripheral arterial disease
Atherothrombosis occurs when a blood clot (thrombus) forms on a ruptured plaque (atheroma) in the wall of a blood vessel. Plaques consist of fatty acids and cholesterol, calcium and other materials.
The rupture of plaques and the subsequent development of a clot can cause partial or complete blockage of an artery in various parts of the body. When a vessel in the heart is partially or completely blocked by a clot the result can be a heart attack. In the brain, the same process can cause a stroke. Elsewhere in the body, this process can lead to reduction or blockage of blood flow in the arteries of the legs - peripheral arterial disease or PAD - a significant risk factor for heart attack or stroke.
Atherothrombosis is thus the common thread linking heart attack, stroke and peripheral arterial disease.
The REACH Registry is sponsored by sanofi-aventis and Bristol-Myers Squibb.
Notes to Editors:
REACH Registry Baseline Publication:
DL. Bhatt, PG Steg, EM.Ohman, AT.Hirsch, Y.Ikeda, JL.Mas, S.Goto, C-S.Liau, AJ.Richard, J.Rother, PWF.Wilson, on behalf of the REACH Registry Investigators. International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients with Atherothrombosis. JAMA 2006;295:180-9.
REACH Registry Scientific Council:
- Philippe Gabriel Steg, AP-HP, Hopital Bichat-Claude Bernard, Paris, France (co-chair)
- Deepak L. Bhatt, Cleveland Clinic Foundation, Cleveland, USA (co-chair)
- E. Magnus Ohman, Duke University, Durham, NC, USA
- Joachim Rother, Universitat-Klinikum Hamburg Eppendorf, Hamburg, Germany
- Peter F. Wilson, Medical University of South Carolina, Charleston, USA
Source: prnewswire
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