Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH Registry

Abstract

Cardiovascular event rates have been shown to increase substantially with the number of symptomatic disease locations. We sought to assess the risk profile, management and subsequent event rates of polyvascular disease patients. Consecutive outpatients were assessed for atherosclerotic risk factors and medications in the REACH Registry. A total of 19,117 symptomatic patients in Europe completed a 2-year follow-up: 77.2% with single arterial bed disease (coronary artery or cerebrovascular or peripheral arterial disease) and 22.8% with polyvascular disease (≥ 1 disease location). Polyvascular disease patients were older (68.5 ± 9.4 vs 66.3 ± 9.9 years, p < 0.0001), more often current or former smokers (64.9% vs 58.7%, p < 0.0001), and more often suffered from hypertension (59.5% vs 46.6%, p < 0.0001) and diabetes (34.5% vs 25.9%, p < 0.0001) than single arterial bed disease patients. Despite more intense medical therapy, risk factors (smoking, hypertension, low fasting glucose, and low fasting total cholesterol) were less often controlled in polyvascular disease patients. This was associated with substantially more events over 2 years compared with single arterial bed disease patients (cMACCE [cardiovascular death/non-fatal stroke/non-fatal MI] odds ratio, 1.63 [95% CI, 1.45—1.83], p < 0.0001). In conclusion, polyvascular disease patients have more cardiovascular risk factors, and the prognosis for these patients is significantly worse than for patients with single arterial bed disease. This suggests a need to improve detection and consequent medical treatment of polyvascular disease.

Prevalence and Clinical Outcome of Polyvascular Atherosclerotic Disease in Patients Undergoing Coronary Intervention

“…The incidence of MACE in patients with and without polyVD (excluding AAA, RAS) was 12.7% and 6.1%, respectively, at 2-year follow-up in the European REACH registry, 20 and 12.1% and 3.8%, respectively, in the current study. The rate of MACE in all patients with polyVD was similar between the 2 registries.…”

Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease

“…[1][2][3] Thus, patients with symptomatic PAD are at heightened risk of major adverse cardiovascular events (MACE) including myocardial infarction, stroke, and cardiovascular death. 4,5 In addition, it is important to note that patients with PAD experience significant morbidity from major adverse limb events (MALE) including acute limb ischemia, urgent peripheral revascularization, and major amputation.…”

Results of the Clinical Trial Fourier. New Opportunities for Treatment of Very High Cardiovascular Risk Patients

“…Так, по данным регистра REACH (REduction of Atherothrombosis for Continued Health) среди пациен-тов, имеющих многососудистое поражение и перене-сенное событие в прошлом, практически у половины (47%) в течение 4 лет отмечалось развитие комбиниро-ванной конечной точки, включавшей сердечно-сосу-дистую смерть, инфаркт миокарда, инсульт и госпита-лизацию по сердечно-сосудистым причинам. В то время как пациентов с однососудистым пораже-нием без перенесенных ранее событий со стабильным течением атеросклеротического заболевания этот показатель составлял 31% [15]. Другим мощным небла-гоприятным фактором повторных событий является срок, прошедший после первичного ишемического события.…”