Assessment of Atherothrombosis and Its Treatment in Mexico: First‐Year Data of the REACH Registry

Abstract

Background: Atherothrombosis, a generalized and progressive process, is currently a major healthcare problem in Mexico. Methods: The worldwide Reduction of Atherothrombosis for Continued Health (REACH) registry aimed to evaluate risk factors for atherosclerosis, long-term cardiovascular (CV) event rates, and current management of either patients with established symptomatic atherosclerotic disease or asymptomatic subjects with multiple risk factors for atherothrombotic disease. One-year follow-up of the global REACH database was available for 64 977 outpatients. This report includes the Mexican subregistry wherein 62 internists, cardiologists, and neurologists evaluated baseline patient characteristics, risk factors, medications, and CV event rates as primary outcomes at 1-year follow-up. Results: Complete 1-year follow-up data were available for 837 Mexicans. We observed a high prevalence of diabetes (47.1%), hypertension (74.7%), and hypercholesterolemia (57.8%). Antiplatelet, antihypertensive and/or glucose-lowering agents, and lipid-lowering drugs were used in 87.6%, 84.1%, and 61% of patients, respectively. The all-cause mortality rate was 3.3%. The composite outcome CV death/myocardial infarction/stroke/hospitalization for atherothrombotic events was higher in the symptomatic group (14.6%) than in asymptomatic subjects with multiple risk factors (5.1%; P = 0.01), similar to Latin American results of the global REACH report. The highest CV event rate occurred among symptomatic atherothrombotic patients with 3 vascular disease locations (30.2%), followed by those with 2 (21.9%) and 1 location (13.4%; P = 0.0006). Conclusions: Prevalence of risk factors and CV event rates including hospitalization in Mexican atherothrombotic patients was high despite the current medication use, which suggests it is necessary to have more aggressive risk-factor management.The REACH registry is sponsored by sanofi-aventis, BristolMyers Squibb, and the Waksman Foundation of Japan (Tokyo, Japan). The REACH registry is endorsed by the World Heart Federation. A complete list of REACH investigators is accessible online at www.reachregistry.org. The REACH registry enforces a no-ghostwriting policy. This manuscript was written and edited by the authors, who take full responsibility for its content. The first draft was written by Dr. Efraín Gaxiola. 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. Dr. Efraín Gaxiola has received research grants from sanofiaventis, speaker fees from Pfizer and Eli Lilly, and fees as an advisory board member from Abbott Labs and Pfizer. Dr. Luis Eng-Ceceña has received speaker fees from sanofi-aventis, Pfizer, Bayer, and AstraZeneca, and fees as advisory board member from Schering-Plough. Dr. Fernando Ortiz-Galván

Risk Factors, Therapeutic Approaches, and In‐Hospital Outcomes in Mexicans With ST‐Elevation Acute Myocardial Infarction: The RENASICA II Multicenter Registry

“…Nevertheless, this prevalence of DM in Mexicans with atherothrombotic disease is consistent with that previously observed in other registries. 5,6 Of note, in this Mexican registry the proportion of STEMI cases among ACS patients is comparable with that of registries from high-income countries, such as the Global Registry of Acute Cardiac Events (GRACE), the National Registry of Myocardial Infarction (NRMI), and Euro Heart Survey (EHS) 1 and 2 ( Table 5). The frequencies of hypertension and male sex and the 30-day case fatality rate are also comparable; however, the distribution of other traditional risk factors shows important differences between Mexico and high-income populations.…”

“…Sanofi, however, did not participate either directly or indirectly in the study design, patient selection, data capture, data analysis, manuscript drafting, or the decision to submit the article for publication. (16); Norberto Matadamas, Hospital General, Acapulco, Guerrero (15); Héctor Barragán Mar, Hospital Metropolitano, Mexico City (13); Carlos Hernández Herrera, Hospital Especialidades, Monclova, Coahuila (9); Hugo Aguilar Castillo, Hospital ''Darío Fernández'' ISSSTE, Mexico City (9); Marco Antonio Susarrey, Hospital Cardiomed, Ensenada, Baja California Norte (9); Abel Pavia, Hospital General SSA, Mexico City (8); Miguel A. Romo, Hospital ''San José,'' Zacatecas (8); Demetrio Kosturakis and Arturo Monroy, Hospital CIMA, Chihuahua (7); José Luisálvarez Cabrera, Centro Médico Naval, Mexico City (7); and Adrián Medina Amarilla, Hospital ALMATER, Mexicali, Baja California Norte (5). Coordinators for RENASICA II nonmedical personnel: Mely Colomer, Cristina Gaytán, Cristina Guerrero, Alfredo Gutiérrez, Xenia Cruz, Lorena Vasto, Miguel Wilson, and Leonor Gómez.…”

“…10 -12 However, these data may not be generalizable to LMICs. 5,6 Although observational studies complement information from randomized controlled trials, historically they have been restricted largely to Western populations. 13 Only very recently have observational studies on ACS been conducted in Mexico.…”

Atherothrombotic Disease, Traditional Risk Factors, and 4‐Year Mortality in a Latin American Population: The REACH Registry

“…All clinical events during the follow‐up relied upon the investigator's imputation. Different combinations of prespecified study outcomes were modeled from the registered events 7–10. For the purpose of the present report, cardiovascular and all‐cause case fatality rates are analyzed.…”

“…The worldwide Reduction of Atherothrombosis for Continued Health (REACH) study is a registry of stable outpatients with a wide spectrum of atherothrombosis, from asymptomatic individuals at risk to patients with established arterial disease (CAD, CVD, and PAD) 7–10. This registry represents an important dataset to analyze the factors responsible for atherothrombotic complications and mortality in the contemporary real‐practice world.…”