Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with
Deepak L Bhatt1, Kim A Eagle, E Magnus Ohman
1VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02132, USA. dlbhattmd@post.harvard.edu
JAMA
|September 1, 2010
Summary
Identifying patients at high risk for cardiovascular events is crucial. Prior ischemic events, polyvascular disease, and diabetes significantly increase future cardiovascular risk in outpatients with atherothrombosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Risk Stratification
Background:
- Identifying patients at high risk for cardiovascular events is challenging for clinicians.
- Prior ischemic events, polyvascular disease, and diabetes mellitus are known predictors, but their comparative risk contributions are unclear.
Purpose of the Study:
- To categorize cardiovascular event risk in stable outpatients with atherothrombosis using simple clinical descriptors.
- To improve risk assessment for patients with established or potential atherothrombotic disease.
Main Methods:
- The Reduction of Atherothrombosis for Continued Health (REACH) Registry enrolled 45,227 outpatients with coronary, cerebrovascular, or peripheral artery disease, or multiple risk factors.
- Patients were followed for up to 4 years across 3647 centers in 29 countries.
- Primary outcomes included cardiovascular death, myocardial infarction, and stroke.
Main Results:
- Patients with a prior ischemic event had the highest subsequent event rate (18.3%).
- Patients with stable coronary, cerebrovascular, or peripheral artery disease had a lower risk (12.2%).
- Diabetes (HR 1.44), recent ischemic event (HR 1.71), and polyvascular disease (HR 1.99) were independently associated with significantly higher risk.
Conclusions:
- Simple clinical descriptors can effectively identify high-risk outpatients with atherothrombosis.
- Risk stratification aids clinicians in managing patients with diverse manifestations of atherothrombosis.
- The study highlights the significant impact of prior events and polyvascular disease on future cardiovascular risk.
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