Background: Prior investigations to define ethnic-related differences in the risks, medical treatment, and outcomes of patients with peripheral arterial disease (PAD) have been limited. Methods: The impact of ethnicity on the risk factor profiles, use of evidence-based medical therapies, and 2-year cardiovascular outcomes were investigated in 2,168 individuals (blacks n = 237, Hispanics n = 115, whites n = 1,816) from the United States with PAD from the international Reduction of Atherothrombosis for Continued Health Registry. Results: Blacks and Hispanics were more likely to have diabetes mellitus and hypertension, whereas whites had a higher rate of diagnosed hypercholesterolemia. Control of blood pressure and cholesterol levels differed significantly in the groups at baseline: elevated blood pressure was present in 55% of blacks versus 48% of Hispanics versus 38% of whites (P < .01), whereas 41% of blacks versus 31% of Hispanics versus 25% of whites had elevated total cholesterol (P < .01). Aspirin use (62% of blacks vs 68% of Hispanics vs 72% of whites, P < .01) and statin use (72% of blacks vs 68% of Hispanics vs 77% of whites, P = .03) also varied significantly. In this context, rates by ethnicity for cardiovascular death, myocardial infarction, or stroke seemed to be no different at 2 years, at 8.8% for the total population: 11.6% for blacks, 8.5% for whites, and 5.0% for Hispanics (P = .32). Fewer blacks (0.6%) had undergone peripheral arterial bypass surgery compared with whites (3.4%) and Hispanics (5.2%) (P = .02). Conclusions: Ethnic-related differences have been documented in the prevalence and treatment of several atherosclerotic risk factors known to be associated with PAD, including a variation in the use of surgical revascularization procedures.
Bibliographical noteFunding Information:
Dr Meadows has no disclosures. Dr Bhatt has received research grants (to the institution) from Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, sanofi-aventis, and The Medicines Company. Dr Bhatt has served as a consultant (honoraria waived or donated for past 3 years) for Arena, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Johnson and Johnson, McNeil, Medtronic, Millennium, Molecular Insights, Otsuka, Paringenix, PDL, Philips, Portola, sanofi-aventis, Schering Plough, Takeda, The Medicines Company, and Vertex. Dr Hirsch has received a research grant from sanofi-aventis and Bristol-Myers Squibb. Dr Creager has received research grants from sanofi-aventis and Merck, and has received honoraria for consulting or speaking from Biomarin, Genzyme, sanofi-aventis, Sigma Tau, and Vascutek. Dr Califf has received research contracts and consulting fees from sanofi-aventis; all personal income donated to nonprofits; all industry relations posted at dcri.duke.edu/coi.jsp. Dr Ohman receives research grants from AstraZeneca, Bristol-Myers Squibb, CV Therapeutics Inc, Daiichi Sankyo, Datascope, Eli Lilly and Company, sanofi-aventis, Schering-Plough Corporation, and The Medicines Company; provides consulting or other services for Abiomed, CV Therapeutics Inc, Datascope, Inovise, Liposcience, Northpoint Domain, Pozen Inc, Response Biomedical, sanofi-aventis, The Medicines Company, and WebMD (theheart.org); and has equity in Inovise. Dr Cannon currently receives research grant support from Accumetrics, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, sanofi-aventis, and Schering Plough. Dr Eagle has received research grants from Biosite, Bristol-Myers Squibb, Cardiac Sciences, Blue Cross Blue Shield of Michigan, Hewlett Foundation, Mardigian Fund, Pfizer, sanofi-aventis, and the Varbedian fund and is a consultant/advisory board member for National Heart, Lung, and Blood NIH, Pfizer Inc, and sanofi-aventis. Dr Alberts has received research grants from AGA Medical, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Novo Nordisk, Photo Thera, sanofi-aventis, and Schering-Plough; is a consultant for AGA Medical, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly and Co, Genentech, KOS, The Medicines Company, Merck, Novo Nordisk, PDL BioPharma Inc, Pfizer, and sanofi-aventis; is on the Speaker's bureau for AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, diaDexus, Genentech, The Medicines Company, Medscape, Novo Nordisk, PDL BioPharma Inc, and sanofi-aventis; is an advisory board member for AGA Medical, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly and Co, Genentech, KOS, The Medicines Company, Merck, Novo Nordisk, Pfizer, and sanofi-aventis; and receives honoraria from AGA Medical, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, diaDexus, Eli Lilly and Co, Genentech, KOS, The Medicines Company, Medscape, Merck, Novo Nordisk, PDL BioPharma Inc, Pfizer, sanofi-aventis, TAP Pharmaceuticals-DSMB, and Schering-Plough. Professor Goto has received honoraria and consulting fees from Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Kowa, Novartis, Otsuka, sanofi-aventis, Schering-Plough, and Takeda. Professor Goto also received research grants from Eisai, Ono, sanofi-aventis, AstraZeneca, Kowa, and Pfizer within the past 3 years. Dr Smith has no disclosures. Dr Wilson has received grant support from sanofi-aventis. Dr Watson has served as a consultant for Bristol Myers Squibb, GlaxoSmithKline, KOS, Merck, Novartis, Pfizer, and Schering-Plough and is on the Speaker's bureau for Bristol Myers Squibb, GlaxoSmithKline, KOS, Merck, Novartis, Pfizer, and Schering-Plough. Dr Steg has received research grants from sanofi-aventis and has been either speaker or consultant for Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Endotis, GlaxoSmithKline, Medtronic, MSD, Nycomed, sanofi-aventis, Servier, and The Medicines Company.
The first draft was written by Dr Meadows. We thank the REACH Editorial Support Group for providing editorial help and assistance in preparing this manuscript including editing, checking content and language, formatting, referencing, and preparing tables and figures. Statistical support was provided by Lucie Parent from Teamlog and Geneviève Salette from sanofi-aventis. The REACH registry is endorsed by the World Heart Federation. A complete list of REACH investigators is accessible online at www.reachregistry.org .
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