Patients with arterial disease have relatively high rates of experiencing a cardiovascular event (such as heart attack, stroke or cardiovascular death) within one year, and these increase with the number of arterial locations afflicted, according to a large, international study in the March 21 issue of JAMA.
Atherothrombosis (arterial disease, such as coronary artery disease [CAD], cerebrovascular disease [CVD], and peripheral arterial disease [PAD; narrowing of the arteries that supply the legs and feet]) is associated with the main causes of death on a worldwide scale, according to background information in the article. "Recent U.S. data have confirmed that, despite a decrease in age-standardized national death rates, the absolute number of deaths from these conditions continues to increase, and prevalence is sharply increasing in other parts of the world. Thus, atherothrombotic diseases are, and are projected still to be, the leading cause of death worldwide by 2020." Few studies have documented the current cardiovascular (CV) event rates in outpatients with atherothrombosis.
Ph. Gabriel Steg, M.D., of the Hôpital Bichat-Claude Bernard, Paris, and colleagues examined the characteristics and CV event rates of patients for whom 1-year follow-up data were available from the Reduction of Atherothrombosis for Continued Health (REACH) Registry, an international group of 68,236 patients with either established atherosclerotic arterial disease (such as CAD, PAD, CVD; n = 55,814) or at least three risk factors for atherothrombosis (n = 12,422). The participants were enrolled from 5,587 physician practices in 44 countries in 2003-2004.
As of July 2006, 1-year outcomes were available for 95 percent (n = 64,977) of participants. The researchers found that in the overall stable population with established arterial disease, approximately 1 in 7 patients had a cardiovascular event (CV death, heart attack, and stroke) or was hospitalized for a CV event or revascularization procedure within a year of enrollment. Patients with established arterial disease experienced 2 to 3 times higher event rates than patients with multiple risk factors only.
The overall combined CV death, heart attack, or stroke rate at 1 year was 4.24 percent, ranging from 2.15 percent of patients with multiple risk factors only to 6.47 percent of patients enrolled with CVD and 4.69 percent for those with established atherosclerotic arterial disease.
Among patients with established disease, CV death, heart attack, or stroke rates were 4.52 percent for patients with CAD and 5.35 percent for patients with PAD. The incidences of CV death, heart attack, or stroke or of hospitalization for atherothrombotic event(s) were 15.20 percent for CAD, 14.53 percent for CVD, and 21.14 percent for PAD patients with established disease. These event rates increased directly with the number of symptomatic arterial disease locations, from 5.31 percent for patients with risk factors only, to 12.58 percent for patients with one, 21.14 percent for patients with two and 26.27 percent for patients with three symptomatic arterial disease locations.
"The high event rates observed in this large, stable, contemporary outpatient cohort of patients with established atherosclerotic arterial disease or with multiple atherothrombotic risk factors indicate that continued efforts are needed to improve secondary prevention and clinical outcomes. Initiatives to improve adherence to evidence-based guidelines and care are an important tool in this respect. In addition, the strong association of asymptomatic and symptomatic multiple locations of atherothrombosis with event rates suggests that atherothrombosis should be addressed as a global arterial disease in patients," the authors conclude.
Dr. McDermott reports that she has received honoraria from Bristol-Myers Squibb, Sanofi-Aventis, NicOx, and Otsuka Pharmaceutical, has served as a consultant for Hutchinson Technology, and is currently receiving support from research grants from the National Heart, Lung, and Blood Institute.
Reference: JAMA. 2007;297:1197-1206
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