Atherothrombotic disease, traditional risk factors, and 4-year mortality in a Latin American population: the REACH Registry.
BACKGROUND
Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk.


OBJECTIVE
Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort.


METHODS
We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry.


RESULTS
Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index <20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥ 65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥ 30 (HR: 0.58) were associated with a reduced risk.


CONCLUSIONS
Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin American cohort. Nearly one-third of the population with 3 symptomatic vascular-disease locations died at 4-year follow-up.
Department of Neurology and Psychiatry, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico. carloscantu_brito@hotmail.com
Carlos
C
Cantú-Brito
Erwin
E
Chiquete
José L
JL
Ruiz-Sandoval
Efraín
E
Gaxiola
Denilson C
DC
Albuquerque
Ramón
R
Corbalán
Alma
A
Ramos
Deepak L
DL
Bhatt
P Gabriel
PG
Steg
D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D010045:Outpatients; D012042:Registries; D012307:Risk Factors; D013997:Time Factors