BARCELONA — Three-year follow-up data from the 44-nation REACH registry provide unprecedented insight into the course of atherothrombotic disease in contemporary community-based primary care medical practices around the world. And it's not a pretty picture.
Indeed, more than one-quarter of the 32,347 patients with baseline symptomatic atherothrombotic disease who were followed for 3 years experienced vascular death, nonfatal MI or stroke, or rehospitalization for a different vascular event during that time period, Dr. Mark J. Alberts reported at the annual congress of the European Society of Cardiology.
“Extrapolated across a global population, this really represents tens of millions—if not hundreds of millions—of events that are affecting these patients,” said Dr. Alberts, professor of neurology and director of the stroke program at Northwestern University, Chicago.
REACH (Reduction of Atherothrombosis for Continued Health) is the largest worldwide registry of patients with all types of atherothrombotic disease. To participate in the observational registry, patients had to have stable established coronary artery disease (CAD), cerebrovascular disease, and/or peripheral artery disease (PAD), or at least three atherothrombotic risk factors. Although the overall 3-year rate of the combined end point of vascular death, nonfatal MI or stroke, or rehospitalization for a different vascular event was 28%, in patients with baseline PAD it was 40%. This was significantly greater than for patients with baseline atherothrombotic disease in other vascular beds. The PAD group had a particularly high rate of hospitalization for a vascular event other than MI, stroke, or death; hospitalizations accounted for more than three-quarters of the composite end points in the PAD group.
In the patients with monovascular, symptomatic disease at baseline, the 3-year rate of the combined end point was 26%, compared with 41% in those with baseline polyvascular disease.
Patients with PAD only at baseline were more likely than those with other forms of monovascular disease to progress to involvement of additional vascular beds during 3 years of follow-up. Indeed, nearly 10% of patients with PAD progressed to polyvascular disease, a rate Dr. Alberts called “alarming” in light of the very high vascular event rate associated with polyvascular disease. By comparison, only about 4% of patients with symptomatic monovascular CAD or cerebrovascular disease at enrollment progressed to polyvascular disease.
The high vascular event rates documented in REACH occurred despite high rates of guideline-recommended therapies. REACH is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation for Microbiology. Dr. Alberts reported having received research grants, honoraria, and consulting fees from Sanofi-Aventis, Bristol-Myers Squibb, AstraZeneca, Genentech, Schering-Plough, and Boehringer Ingelheim.
'This really represents tens of millions—if not hundreds of millions—of events.'
Source DR. ALBERTS