International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.
BACKGROUND
Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis.


OBJECTIVE
To determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world.


METHODS
The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67,888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40,258; cerebrovascular disease, n = 18,843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12,389) between 2003 and 2004.


METHODS
Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control.


RESULTS
Atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P<.001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for > or =3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease.


CONCLUSIONS
This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.
Bhatt
Deepak L
DL
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. bhattd@ccf.org
Steg
P Gabriel
PG
Ohman
E Magnus
EM
Hirsch
Alan T
AT
Ikeda
Yasuo
Y
Mas
Jean-Louis
JL
Goto
Shinya
S
Liau
Chiau-Suong
CS
Richard
Alain J
AJ
Röther
Joachim
J
Wilson
Peter W F
PW
D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000628:therapy; D004363:Drug Utilization; D005260:Female; D014943:Global Health; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000628:therapy
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors