Risk factor profile and management of cerebrovascular patients in the REACH Registry.
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 >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 >or=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 >or=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.
Röther
Joachim
J
Department of Neurology, Klinikum Minden, Hannover Medical School, Minden, Germany. joachim.roether@klinikum-minden.de
Alberts
Mark J
MJ
Touzé
Emmanuel
E
Mas
Jean-Louis
JL
Hill
Michael D
MD
Michel
Patrik
P
Bhatt
Deepak L
DL
Aichner
Franz T
FT
Goto
Shinya
S
Matsumoto
Masayasu
M
Ohman
E Magnus
EM
Okada
Yasushi
Y
Uchiyama
Shinichiro
S
D'Agostino
Ralph
R
Hirsch
Alan T
AT
Wilson
Peter W F
PW
Steg
P Gabriel
PG
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D014943:Global Health; D017408:Guidelines as Topic; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D002537:Intracranial Arteriosclerosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors