Atherothrombosis Seen as Prelude to Major Cardiovascular Event

PARIS, March 20 -- Atherosclerotic arterial disease seems to predict relatively high rates of myocardial infarction, stroke, or cardiovascular death within a year, according to a large, international registry study.

In an overall stable population with arterial disease at baseline, about one in seven patients had a cardiovascular event or was hospitalized for an event or a revascularization procedure within a year, found a prospective cohort study reported in the March 21 issue of the Journal of the American Medical Association.

Patients with established arterial disease had event rates two to three times higher than those with multiple risk factors only, Ph. Gabriel Steg, M.D., of Hpital Bichat-Claude Bernard here, and colleagues, found in an analysis of 68,236 patients.

Atherothrombotic diseases are the leading cause of death worldwide, said Dr, Steg and colleagues. Yet, they said, few studies have documented the current cardiovascular event rates in these patients. .

Of the patients, 55,814 had established atherosclerotic arterial disease (coronary artery disease, peripheral arterial disease, cerebrovascular disease), while 12,422 had at least three risk factors for atherothrombosis, showed findings from the Reduction of Atherothrombosis for Continued Health (REACH) Registry.

The patients, mean age 68.6, and 64% male, were enrolled from 5,587 physician practices in 44 countries from 2003 to 2004. The majority of patients were either overweight or obese, was former or current smokers, and had a history of coronary disease.

As of July 2006, one-year outcomes were available for 95.22% of 64, 977participants. Cardiovascular death, MI, or stroke rates were 4.24% overall (95% CI 3.97% to 4.51%), ranging from 4.69% for those with established atherosclerotic arterial disease to 2.15% for patients with multiple risk factors only.

Among patients with established disease, cardiovascular death, MI, or stroke rates were 4.52% for patients with coronary artery disease, 6.47% for patients with cerebrovascular disease, and 5.35% for patients with peripheral artery disease.

For patients with established disease, the rates of an atherothrombotic event for the endpoints of cardiovascular death, MI, stroke, or hospitalization were 15.20% for coronary artery disease, 14.53% for cerebrovascular disease, and 21.14% for peripheral artery disease.

These event rates, the researchers said, increased with the number of symptomatic arterial disease locations, ranging from 5.31% for patients with risk factors only to 12.58% for patients with one symptomatic arterial disease location, to 21.14% for patients with two locations, and 26.27% for patients with three locations (P

In addition, they said, a 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 an accompanying editorial Mary McGrae McDermott, M.D., of Northwestern University in Chicago, wrote that the REACH Registry shows that the cardiovascular disease epidemic remains a critical and urgent international public health problem.

Despite recent substantial progress in the understanding of cardiovascular disease pathophysiology and optimal therapies for cardiovascular disease, Dr. McDermott wrote, major challenges remain to prevent cardiovascular events and disability in patients with established cardiovascular disease.

Dr. McDermott also pointed out the the possibility of bias in physician selection of participants for the study as well as the possibility of bias due to the fact that office practices were not randomly selected for participation.

The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan), who assisted with the design and conduct of the study and data collection.

Dr. McDermott, the editorial writer, reported 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 research grants from the National Heart, Lung, and Blood Institute.