Aims To determine 3-year event rates in outpatients with vascular disease enrolled in the REduction of Atherothrombosis for Continued Health (REACH) Registry.Methods and resultsREACH enrolled 67 888 outpatients with atherothrombosis [established coronary artery disease (CAD), cerebrovascular disease, or peripheral arterial disease (PAD)], or with at least three atherothrombotic risk factors, from 44 countries. Among the 55 499 patients at baseline with symptomatic disease, 39 675 were eligible for 3-year follow-up, and 32 247 had data available (81% retention rate). Among the symptomatic patients at 3 years, 92% were taking an antithrombotic agent, 91% an antihypertensive, and 76% were on lipid-lowering therapy. For myocardial infarction (MI)/stroke/vascular death, 1- and 3-year event rates for all patients were 4.2 and 11.0%, respectively. Event rates (MI/stroke/vascular death) were significantly higher for patients with symptomatic disease vs. those with risk factors only at 1 year (4.7 vs. 2.3%, P < 0.001) and at 3 years (12.0 vs. 6.0, P < 0.001). One and 3-year rates of MI/stroke/vascular death/rehospitalization were 14.4 and 28.4%, respectively, for patients with symptomatic disease. Rehospitalization for a vascular event other than MI/stroke/vascular death was common at 3 years (19.0% overall; 33.6% for PAD; 23.0% for CAD). For patients with symptomatic vascular disease in one vascular bed vs. multiple vascular beds, 3-year event rates for MI/stroke/vascular death/rehospitalization were 25.5 vs. 40.5% (P < 0.001).Conclusion Despite contemporary therapy, outpatients with symptomatic atherothrombotic vascular disease experience high rates of recurrent vascular events and rehospitalizations.
Bibliographical noteFunding Information:
The REACH Registry is sponsored by sanofi-aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan). Funding to pay the Open Access publication charges for this article was provided by sanofi-aventis and Bristol-Myers-Squibb.
M.J.A. has received research grants, honoraria, and consulting fees from sanofi-aventis, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Genentech, Boehringer Ingelheim; honoraria and consulting fees from The Medicines Company, Pfizer, PDL Biopharm Diadexus; and consulting fees from Eli Lilly, Merck, GlaxoSmithKline, Biosite, Cardax.
E.M.O. has received grant support from Bristol-Myers Squibb, sanofi-aventis, Schering-Plough, Millennium Pharmaceuticals, Eli Lilly, and Berlex; consultancy fees from Inovise, Savacor, Liposcience, Response Biomedical, The Medicines Company, Datascope, and Abiomed; payment for speaker’s bureau from CV Therapeutics and Schering-Plough within the last 3 years and is a shareholder of Inovise, Savacor, and Medtronic.
A.T.H. has received research grants from Bristol-Myers Squibb and sanofi-aventis, and honoraria from sanofi-aventis.
S.G. has received honoraria and consulting fees from Eisai, sanofi-aventis, Daiichi-Sankyo, GlaxoSmithKline, Bristol-Myers Squibb, Otsuka, Bayer, Schering-Plough, Takeda, Astellas, AstraZeneca, Novar-tis, and Kowa; has received research grants from Pfizer, Ono, Eisai, Otsuka, Daiichi-Sankyo, sanofi-aventis, Takeda, and Astellas within the past 3 years. S.S. has no disclosures. C.-S.L. has no disclosures.
Ph.G.S. has received research grant from sanofi-aventis (1999– 2008); is on the speaker’s bureau for Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Menarini, Medtronic, Nycomed, Pierre Fabre, sanofi-aventis, Servier, and The Medicines Company; is on the consulting/advisory boards for Astellas, AstraZe-neca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Endotis, GlaxoSmithKline, Medtronic, MSD, Nycomed, sanofi-aventis, Servier, and The Medicines Company; and is a stockholder for Aterovax.
- Cerebrovascular disease
- Coronary artery disease
- Peripheral arterial disease
- Risk factors