Cardiovascular event rates in patients with cerebrovascular disease and atherothrombosis at other vascular locations: Results from 1-year outcomes in the Japanese REACH Registry
Received 12 March 2009; received in revised form 13 August 2009; accepted 10 September 2009. published online 08 October 2009.
Abstract
The REduction of Atherothrombosis for Continued Health (REACH) Registry is a large, international, prospective cohort of patients with atherothrombosis or multiple (≥3) risk factors (MRFs) for atherothrombosis.
Japanese patients (n=5193) were enrolled into the REACH registry between August and December 2004. One-year event rate in patients with cerebrovascular disease (CVD) was compared with that of patients with symptomatic atherothrombosis at other locations.
After one year (n=5021), patients with CVD (n=1962) experienced a higher rate of non-fatal strokes than patients with coronary artery disease (CAD), peripheral artery disease (PAD) or MRFs alone (2.77% vs. 1.28%, 2.07% and 1.56%, respectively), but a lower rate of non-fatal myocardial infarction (0.45% vs. 1.31%, 0.77% and 0.66%, respectively). Patients with CVD plus disease in ≥1 other vascular bed had higher rates of cardiovascular events than patients with CVD alone. Overall, event rates including non-fatal stroke, non-fatal myocardial infarction and cardiovascular death were higher for patients with CVD and PAD than for patients with CVD and CAD. Asymptomatic carotid stenosis ≥70% and ankle-brachial index <0.9 were significant predisposing factors for stroke.
Patients with CVD and co-existing atherothrombotic diseases had a high risk of recurrent events, including events arising in other vascular beds than originally diagnosed.
aDepartment of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
bDepartment of Medicine, Tokai University School of Medicine, Kanagawa, Japan
cDepartment of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
dDepartment of Cardiology, University of Tokyo, Tokyo, Japan
eDivision of Biostatistics and Clinical Epidemiology, University of Toyama, Toyama, Japan
fDepartment of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
gDepartment of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
hDepartment of Cardiology, Jichi Medical University, Tochigi, Japan
iDepartment of Metabolism and Endocrinology, University of Tsukuba, Ibaraki, Japan
jVA Boston Healthcare System and Brigham and Women's Hospital, Boston, USA
kINSERM U-698, Université Paris 7 and Assistance Publique, Hôpitaux de Paris, Paris, France
lDepartment of Medicine, Keio University School of Medicine, Tokyo, Japan
Corresponding author. Department of Neurology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Tel.: +81 3 3353 8111; fax: +81 3 3341 0613.