The REduction of Atherothrombosis for Continued Health (REACH) Registry: An international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design
Duke University, Durham, North Carolina, United States American heart journal
(Impact Factor: 4.46).
04/2006; 151(4):786.e1-10. DOI: 10.1016/j.ahj.2005.11.004
The risk of atherothrombosis is a large health care burden worldwide. With its global prevalence, there is a need to understand all the associated risk factors, both old and new, and their interdependencies in the development of this complex disease leading to myocardial infarction, ischemic stroke, and vascular death and, thus, the major cause of mortality throughout the world.
The REACH Registry sought to compile an international data set to extend our knowledge of atherothrombotic risk factors and ischemic events in the outpatient setting. The Registry will recruit approximately 68,000 outpatients in 44 countries across 6 major regions (Latin America, North America, Europe, Asia, the Middle East, and Australia) from >5000 physician outpatient practices. Patients aged > or =45 years with at least 3 atherothrombotic risk factors or documented cerebrovascular, coronary artery, or peripheral arterial disease will be enrolled. Medical history, risk factors, demographic information, and management will be collected at baseline, and clinical events that occur during the follow-up period of up to 2 years in duration will be recorded.
The REACH Registry offers an opportunity to provide a better understanding of the prevalence and clinical consequences of atherothrombosis in the outpatient setting in a wide range of patients from different parts of the world.
Available from: Pascal Delsart
- "Recent studies have shown that approximately 80% of patients suffering from vascular disease whether coronary, cerebral, or peripheral, have hypertension,4 and lowering of arterial BP favorably influences the prognosis, especially in patients with coronary lesions and those with a history of stroke.5,6 "
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ABSTRACT: The influence of hypertension on cardiovascular risk is well known. Ambulatory blood pressure measurement (ABPM) is able to identify patients with masked hypertension (MH) underdetected by clinical BP measurement. The benefit of screening for MH in a high-risk population was investigated.
To detect MH in a population with no prior history of hypertension and medically treated for peripheral or coronary arterial disease.
Thirty-eight consecutive patients with peripheral or coronary artery disease documented with arteriography, without a history of hypertension, and with an admission BP < 140/90 mmHg underwent ABPM after discharge. Ambulatory BP >or= 125/80 mmHg were defined as MH.
MH was found in 11 patients (28.9%). The MH group had a mean systolic and diastolic hospitalization BP significantly higher (127 versus 115 mmHg, respectively, P = 0.002 and 76 versus 66 mmHg, P = 0.01), and tended to have a higher admission systolic BP and pulse pressure (127 versus 121 mmHg, respectively, P = 0.07; and 54 versus 46 mmHg, P = 0.06). The first BP measurement on the 24-hour ABPM was significantly higher in the MH group 140 versus 121 mmHg, P = 0.001, for systolic BP and 84 versus 74 mmHg, P = 0.03, for diastolic BP.
MH was found in patients with documented and medically treated vascular disease. BP in the prehypertensive range is associated with MH. Systematic screening for MH in this high-risk population requires further investigation.
Available from: Philippe Gabriel Steg
- "Atherothrombosis is a common (but not exclusive) underlying cause of these three diseases. Therefore, CVD, PAD and CAD are often different locations of a similar underlying disease, share similar risk factors (albeit with a different relative weight for each of the locations) and frequently coexist . In the REduction of Atherothrombosis for Continued Health (REACH) Registry, there was major overlap between the various locations of the symptomatic location of the disease , and mortality and morbidity increased with the extent of atherosclerotic burden (i.e., number of arterial beds affected) . "
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ABSTRACT: A substantial number of patients with acute myocardial infarction (AMI) have polyvascular disease (PolyVD), defined as cerebrovascular disease (CVD), peripheral arterial disease (PAD) or both.
To investigate the impact of PolyVD on baseline characteristics, management and outcomes.
The Alliance project is a multicentre, cross-sectional database of patients with myocardial infarction throughout France from 2000 to 2005. A pooled analysis of individual patient data was performed by aggregating data from five registries, representing 9783 patients hospitalized for acute coronary syndromes. Data were collected on history of PAD and CVD and correlated to baseline characteristics, management and hospital outcomes.
Eight thousand nine hundred and four patients had full datasets for this analysis (13% with a history of CVD or PAD, 87% without). Patients with PolyVD were older (72 vs 65 years, p<0.0001), had a more frequent history of AMI (26% vs 15%, p<0.0001), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), renal insufficiency (12% vs 3%, p<0.0001) and consistently more risk factors for atherosclerosis (hypertension, dyslipidaemia, smoking, diabetes), but less frequently a body mass index>30 kg/m(2) (14.0% vs 20.1%, p<0.0001) compared to patients with coronary artery disease (CAD) alone. Killip class, left-ventricular ejection fraction and GUSTO risk score were all worse among patients with PolyVD. Management of patients with PolyVD was less aggressive (with later admission and less frequent use of in-hospital angiography or evidence-based therapies at discharge). Mortality of patients with PolyVD was consistently higher than in those with CAD alone, regardless of age. Multivariable analysis, adjusting for age, showed that both PAD (odds ratio 1.36 95% confidence interval 1.03-1.79) and history of CVD (odds ratio 1.74, 95% confidence interval 1.27-2.40) were independent predictors of hospital mortality relative to patients with CAD only.
Patients with PolyVD represented a substantial group among AMI patients, at particularly high risk of death, yet were managed less aggressively than patients with CAD alone. This was associated with markedly higher in-hospital mortality. Further research is warranted to design and test strategies to decrease mortality in this high-risk subset.
Available from: Shinya Goto
- "The main purpose of the current investigation was to analyse information on patients with a history of CABG enrolled in the REACH Registry14,15 and to evaluate the variation in the proportion of patients that fail to attain their target goals for secondary prevention at baseline (i.e. control of hypertension, diabetes, increased cholesterol, smoking cessation, and attainment of BMI in the normal range) and their 1 year outcomes. "
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ABSTRACT: To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG).
Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25-<50, 50-<75, and > or =75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25-<50, 50-<75, and >75% risk factors at goal, respectively; P for trend 0.059).
Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.
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