title: Risk factor profile and management of cerebrovascular patients in the REACH Registry.
abstract: 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.
authors.affiliation: Department of Neurology, Klinikum Minden, Hannover Medical School, Minden, Germany. joachim.roether@klinikum-minden.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touzé
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Franz T
authors.initials: FT
authors.lastname: Aichner
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Ralph
authors.initials: R
authors.lastname: D'Agostino
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors