International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients With Atherothrombosis

TLDR

Atherothrombosis is the leading cause of cardiovascular morbidity and mortality worldwide. This study sought to characterize the prevalence and treatment intensity of atherosclerosis risk factors across countries using the REACH Registry. The authors analyzed data from 67,888 patients aged ≥45 years drawn from 4,473 physician practices in 44 countries, documenting baseline risk factor prevalence, medication use, and control levels. Across the cohort, hypertension (81.8 %), hypercholesterolemia (72.4 %), and diabetes (44.3 %) were highly prevalent, yet treatment was suboptimal—statin use 69.4 %, antiplatelet use 78.6 %, with 50 % of hypertensive patients inadequately controlled, 14.4 % current smokers, and 15.9 % exhibiting symptomatic polyvascular disease.

Abstract

Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis.To determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world.The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67,888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40,258; cerebrovascular disease, n = 18,843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12,389) between 2003 and 2004.Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control.Atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P<.001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for > or =3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease.This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.