A global view of atherothrombosis: baseline characteristics in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial.
BACKGROUND
The manifestations of atherothrombosis such as myocardial infarction, ischemic stroke, limb ischemia, or cardiovascular death pose a global health care burden. Additional therapies to decrease ischemic events in patients with established vascular disease or at risk for developing vascular disease are necessary. We sought to characterize the risk factors and treatments of a diverse contemporary population of patients with atherothrombosis.


METHODS
The CHARISMA trial has enrolled 15,603 patients from around the world. Patients with established coronary, cerebrovascular, or peripheral arterial disease, or those at high risk of developing atherothrombosis due to multiple risk factors, have been randomized to receive either the adenosine diphosphate receptor antagonist clopidogrel or placebo, in addition to background therapy with low- to moderate-dose aspirin.


RESULTS
A high percentage of enrolled patients are being treated with statins and angiotensin-converting enzyme inhibitors. In the CHARISMA population, a total of 75.6% of the population had an abnormal body mass index: 42.2% were overweight and 33.4% were obese, with particularly high rates in the United States, especially of morbid obesity. Correspondingly, the prevalence of diabetes was 42%.


CONCLUSIONS
The CHARISMA trial will further characterize atherothrombosis and provide insight into the role of dual antiplatelet therapy in improving outcomes in patients with multiple risk factors or established vascular disease. Of note, the rates of obesity and diabetes in patients with atherothrombosis throughout the world are particularly alarming.
Bhatt
Deepak L
DL
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. bhattd@ccf.org
Fox
Keith A
KA
Hacke
Werner
W
Berger
Peter B
PB
Black
Henry R
HR
Boden
William E
WE
Cacoub
Patrice
P
Cohen
Eric A
EA
Creager
Mark A
MA
Easton
J Donald
JD
Flather
Marcus D
MD
Haffner
Steven M
SM
Hamm
Christian W
CW
Hankey
Graeme J
GJ
Johnston
S Claiborne
SC
Mak
Koon-Hou
KH
Mas
Jean-Louis
JL
Montalescot
Gilles
G
Pearson
Thomas A
TA
Steg
P Gabriel
PG
Steinhubl
Steven R
SR
Weber
Michael A
MA
Booth
Joan
J
Topol
Eric J
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D000077144:Clopidogrel; D003327:Coronary Disease / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000077144:Clopidogrel; D013988:Ticlopidine