Risk factor profile and management of cerebrovascular patients in the REACH registry

Joachim Röther, Mark J. Alberts, Emmanuel Touzé, Jean Louis Mas, Michael D. Hill, Patrik Michel, Deepak L. Bhatt, Franz T. Aichner, Shinya Goto, Masayasu Matsumoto, E. Magnus Ohman, Yasushi Okada, Shinichiro Uchiyama, Ralph D'Agostino, Alan T. Hirsch, Peter W F Wilson, P. Gabriel Steg

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

Background: Cerebrovascular disease (CVD) is a global public health problem. CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Prevalence of risk factors, comorbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. We assessed these factors in 18,992 CVD patients within a worldwide registry of stable outpatients. Methods: The Reduction of Atherothrombosis for Continued Health Registry recruited >68,000 outpatients (44 countries). The subjects were mainly recruited by general practitioners (44%) and internists (29%) if they had symptomatic CVD, coronary artery disease, peripheral arterial disease (PAD) and/or ≥3 atherothrombotic risk factors. Results: The 18,992 CVD patients suffered a stroke (53.7%), transient ischemic attack (TIA) (27.7%) or both (18.5%); 40% had symptomatic atherothrombotic disease in ≥1 additional vascular beds: 36% coronary artery disease; 10% PAD and 6% both. The prevalence of risk factors at baseline was higher in the TIA subgroup than in the stroke group: treated hypertension (83.5/82.0%; p = 0.02), body mass index ≥30 (26.7/20.8%; p < 0.0001), hypercholesterolemia (65.1/52.1%; p < 0.0001), atrial fibrillation (14.7/11.9%; p < 0.0001) and carotid artery disease (42.3/29.7%; p < 0.0001). CVD patients received antiplatelet agents (81.7%), oral anticoagulants (17.3%), lipid-lowering agents (61.2%) and antihypertensives (87.9%), but guideline treatment targets were frequently not achieved (54.5% had elevated blood pressure at baseline, while 4.5% had untreated diabetes). Conclusions: A high percentage of CVD patients have additional atherothrombotic disease manifestations. The risk profile puts CVD patients, especially the TIA subgroup, at high risk for future atherothrombotic events. Undertreatment is common worldwide and adherence to guidelines needs to be enforced.

Original languageEnglish (US)
Pages (from-to)366-374
Number of pages9
JournalCerebrovascular Diseases
Volume25
Issue number4
DOIs
StatePublished - Apr 24 2008

Keywords

  • Atherothrombosis
  • Cerebrovascular disease, risk factors
  • Epidemiology
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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