REACH registry: Disease burden remains high, despite contemporary therapy
March 12, 2006, Atlanta—The 1-year findings from the REACH registry of 63,129 individuals in whom follow-up was completed showed a 3.5% event rate for cardiovascular death, myocardial infarction, stroke, even in stable patients, with or without a high risk of atherothrombosis, who were well-treated with contemporary therapies. One in 8 patients is hospitalized for a cardiovascular reason. Further, risk increased as the number of symptomatic disease locations increased, with a 1.5% event rate in patients with multiple risk factors to 7.1% in patients with coronary, cerebrovascular, and peripheral arterial disease. The results were presented at the American College of Cardiology meeting, held in Atlanta from March 11-14, 2006.
The authors state these data suggest that atherothrombosis must be addressed as a “global disease” in each patient, rather than treating each vascular bed separately.
The REACH Registry was designed to assess the “real world” risk of a major adverse cardiovascular event in patients with either established atherothrombotic disease or at high risk for it.
Other key findings from the REACH registry include:
- At 1-year, the mean age was 68 and 64% male. Medical history included 44% with diabetes, 82% with hypertension, 72% hypercholesterolemia, 40% overweight (BMI25-<30), 30% obese (BMI>30), 42% former smoker, and 15%current smoker.
- A high intervention rate, 5% in patients with CAD for PCI or CABG; 1.1% in patients with cerebrovascular disease for carotid stenting or surgery; and >10% patients with peripheral arterial disease for peripheral interventions. A 1.3% annual amputation rate in patients with peripheral arterial disease.
- Bleeding leading to hospitalization or transfusion was <1%.
- Event rates seemed to be affected by age, gender, and geographic variations.
- 66% of patients had symptomatic disease in 1 arterial bed, 16% had polyvascular disease, and 18% had multiple risk factors.
- Beta blocker use was 48.9%, ACE inhibitors 48.2%, ARBs 25.4%, anti-platelet therapy 78.6%, aspirin in 67.4%, lipid lowering drugs 75.2%, and statins in 69.4%.
|
Overall Registry Population |
Symptomatic Population |
Multiple Risk Factor Population |
CV mortality |
1.5% |
1.7% |
0.6% |
Nonfatal MI |
1.2% |
1.2% |
0.8% |
Nonfatal stroke |
1.8% |
1.8% |
0.8% |
CV death, MI |
3.5% |
3.9% |
1.7 |
CV death, MI, stroke, hospitalization atherothrombotic events |
12.9% |
14.5% |
5.4% |
|
Cardiovascular mortality was highest in patients with peripheral arterial disease, nonfatal MU highest in patients with coronary artery disease, and stroke highest in patients with cerebrovascular disease.
Event rates increased with the increased number of diseased vascular beds in patients with coronary artery disease. A 2-3 fold increase in event rates was seen in patients with polyvascular disease.
The lowest cardiovascular mortality was seen in patients with only peripheral arterial disease, which is a marker of polyvascular disease.
Inclusion in the REACH Registry required signed informed consent, age ≥45 years, and had ≥1 of 4 atherothrombotic criteria:
- documented cerebrovascular disease, stroke or TIA
- documented coronary disease
- documented historical or current intermittent claudication associated with an ankle brachial index <0.8
- ≥3 atherothrombotic risk factors (age, current smoker, diabetes, hypercholesterolemia, diabetic nephropathy, hypertension, ankle brachial index <0.9 in either leg at rest, asymptomatic carotid stenosis >70%, presence of at least 1 carotid plaque).
The international REACH Registry has 5,473 enrolling sites in 44 countries. A total of 67,888 patients have been registered. The 1-year and 21 month follow-up has been extended to 3 and 4 years.
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