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Risk Factor Profile and Management of Cerebrovascular Patients in the REACH RegistryRöther J.a · Alberts M.J.b · Touzé E.h · Mas J.-L.h · Hill M.D.j · Michel P.k · Bhatt D.L.c · Aichner F.T.p · Goto S.o · Matsumoto M.l · Ohman E.M.d · Okada Y.m · Uchiyama S.n · D’Agostino R.e · Hirsch A.T.f · Wilson P.W.F.g · Steg P.G.i
aDepartment of Neurology, Klinikum Minden, Hannover Medical School, Minden, Germany; bDepartment of Neurology, Northwestern University Medical Center, Chicago, Ill., cDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, dDivision of Cardiology, Duke Medical University, Durham, N.C., eStatistics and Consulting Unit, Boston University, Boston, Mass., fMinneapolis Heart Institute Foundation and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minn., and gCardiology Division, Emory University School of Medicine, Atlanta, Ga., USA; hService de Neurologie, Paris-Descartes University, Hôpital Saint-Anne, and iDépartement de Cardiologie, Hôpital Bichat-Claude Bernard, Paris, France; jDepartment of Clinical Neuroscience, University of Calgary, Foothills Medical Center, Calgary, Alta., Canada; kDepartment of Neurology, Lausanne University Hospital, Lausanne, Switzerland; lDepartment of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, mDepartment of Cerebrovascular Disease, Kyushu Medical Center, Fukuoka, nDepartment of Neurology, Tokyo Women’s Medical College, Tokyo, and oResearch Unit of Atherothrombosis, Tokai University School of Medicine, Isehara, Japan; pDepartment of Neurology, Hospital Wagner-Jauregg, Linz, Austria
Background: Cerebrovascular disease (CVD) is a global public health problem. CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Prevalence of risk factors, comorbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. We assessed these factors in 18,992 CVD patients within a worldwide registry of stable outpatients. Methods: The Reduction of Atherothrombosis for Continued Health Registry recruited >68,000 outpatients (44 countries). The subjects were mainly recruited by general practitioners (44%) and internists (29%) if they had symptomatic CVD, coronary artery disease, peripheral arterial disease (PAD) and/or ≧3 atherothrombotic risk factors. Results: The 18,992 CVD patients suffered a stroke (53.7%), transient ischemic attack (TIA) (27.7%) or both (18.5%); 40% had symptomatic atherothrombotic disease in ≧1 additional vascular beds: 36% coronary artery disease; 10% PAD and 6% both. The prevalence of risk factors at baseline was higher in the TIA subgroup than in the stroke group: treated hypertension (83.5/82.0%; p = 0.02), body mass index ≧30 (26.7/20.8%; p < 0.0001), hypercholesterolemia (65.1/52.1%; p < 0.0001), atrial fibrillation (14.7/11.9%; p < 0.0001) and carotid artery disease (42.3/29.7%; p < 0.0001). CVD patients received antiplatelet agents (81.7%), oral anticoagulants (17.3%), lipid-lowering agents (61.2%) and antihypertensives (87.9%), but guideline treatment targets were frequently not achieved (54.5% had elevated blood pressure at baseline, while 4.5% had untreated diabetes). Conclusions: A high percentage of CVD patients have additional atherothrombotic disease manifestations. The risk profile puts CVD patients, especially the TIA subgroup, at high risk for future atherothrombotic events. Undertreatment is common worldwide and adherence to guidelines needs to be enforced.
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