Original Paper

Risk Factor Profile and Management of Cerebrovascular Patients in the REACH Registry
Joachim Röther^a, Mark J. Alberts^b, Emmanuel Touzé^h, Jean-Louis Mas^h, Michael D. Hill^j, Patrik Michel^k, Deepak L. Bhatt^c, Franz T. Aichner^p, Shinya Goto^o, Masayasu Matsumoto^l, E. Magnus Ohman^d, Yasushi Okada^m, Shinichiro Uchiyamaⁿ, Ralph D'Agostino^e, Alan T. Hirsch^f, Peter W.F. Wilson^g, P. Gabriel Stegⁱ, on behalf of the REACH Registry Investigators

^aDepartment of Neurology, Klinikum Minden, Hannover Medical School, Minden, Germany;
^bDepartment of Neurology, Northwestern University Medical Center, Chicago, Ill.,
^cDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio,
^dDivision of Cardiology, Duke Medical University, Durham, N.C.,
^eStatistics and Consulting Unit, Boston University, Boston, Mass.,
^fMinneapolis Heart Institute Foundation and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minn., and
^gCardiology Division, Emory University School of Medicine, Atlanta, Ga., USA;
^hService de Neurologie, Paris-Descartes University, Hôpital Saint-Anne, and
ⁱDépartement de Cardiologie, Hôpital Bichat-Claude Bernard, Paris, France;
^jDepartment of Clinical Neuroscience, University of Calgary, Foothills Medical Center, Calgary, Alta., Canada;
^kDepartment of Neurology, Lausanne University Hospital, Lausanne, Switzerland;
^lDepartment of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima,
^mDepartment of Cerebrovascular Disease, Kyushu Medical Center, Fukuoka,
ⁿDepartment of Neurology, Tokyo Women's Medical College, Tokyo, and
^oResearch Unit of Atherothrombosis, Tokai University School of Medicine, Isehara, Japan;
^pDepartment of Neurology, Hospital Wagner-Jauregg, Linz, Austria

Address of Corresponding Author

Cerebrovasc Dis 2008;25:366-374 (DOI: 10.1159/000120687)

  Key Words

• Stroke
• Epidemiology
• Atherothrombosis
• Cerebrovascular disease, risk factors

  Abstract

Background: Cerebrovascular disease (CVD) is a global public health problem. CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Prevalence of risk factors, comorbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. We assessed these factors in 18,992 CVD patients within a worldwide registry of stable outpatients. Methods: The Reduction of Atherothrombosis for Continued Health Registry recruited >68,000 outpatients (44 countries). The subjects were mainly recruited by general practitioners (44%) and internists (29%) if they had symptomatic CVD, coronary artery disease, peripheral arterial disease (PAD) and/or 3 atherothrombotic risk factors. Results: The 18,992 CVD patients suffered a stroke (53.7%), transient ischemic attack (TIA) (27.7%) or both (18.5%); 40% had symptomatic atherothrombotic disease in 1 additional vascular beds: 36% coronary artery disease; 10% PAD and 6% both. The prevalence of risk factors at baseline was higher in the TIA subgroup than in the stroke group: treated hypertension (83.5/82.0%; p = 0.02), body mass index 30 (26.7/20.8%; p < 0.0001), hypercholesterolemia (65.1/52.1%; p < 0.0001), atrial fibrillation (14.7/11.9%; p < 0.0001) and carotid artery disease (42.3/29.7%; p < 0.0001). CVD patients received antiplatelet agents (81.7%), oral anticoagulants (17.3%), lipid-lowering agents (61.2%) and antihypertensives (87.9%), but guideline treatment targets were frequently not achieved (54.5% had elevated blood pressure at baseline, while 4.5% had untreated diabetes). Conclusions: A high percentage of CVD patients have additional atherothrombotic disease manifestations. The risk profile puts CVD patients, especially the TIA subgroup, at high risk for future atherothrombotic events. Undertreatment is common worldwide and adherence to guidelines needs to be enforced.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Prof. Dr. Joachim Röther
Department of Neurology, Klinikum Minden, Hannover Medical School
DE-32427 Minden (Germany)
Tel. +49 571 801 3501, Fax +49 571 801 3504
E-Mail joachim.roether@klinikum-minden.de

  Article Information

All manuscripts in the REACH Registry are prepared by independent authors, who are not governed by the funding sponsors, and are reviewed by an academic publications committee before submission. The funding sponsors have the opportunity to review manuscript submissions, but do not have authority to change any aspect of a manuscript.

Received: September 28, 2007
Accepted: December 18, 2007
Published online: March 13, 2008
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 5, Number of References : 34