Transcript REACH Registry slide kit

1
The REACH Registry
An International, Prospective Observational Study in Subjects at Risk of
Atherothrombotic Events in an Outpatient Setting
Updated slide kit, February 2006
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Outline
Background
• Burden of Disease
• Risk of Atherothrombosis
REACH Registry Background
• Rationale and Objectives
• Design
REACH Registry Baseline Results
• High Prevalence of Polyvascular Disease
• Undertreatment of Patients with Atherothrombosis Worldwide
REACH Registry Today and Beyond
• Publications to Date
• Upcoming Analyses and Data Availability
• Participating Organizations and Scientific Committees
Updated slide kit, February 2006
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Background
Updated slide kit, February 2006
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Burden of Disease
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Atherothrombosis – a Generalized and
Progressive Disease Process1,2
Thrombosis
UA
MI
ACS
Ischemic
stroke/TIA
Vascular death
Stable angina
UA=unstable angina; MI=myocardial infarction;
ACS=acute coronary syndrome; TIA=transient ischemic attack
1. Adapted from Libby P. Circulation 2001; 104: 365–372.
2. Drouet L. Cerebrovasc Dis 2002; 13(Suppl 1): 1–6.
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Major Role of Platelets in Atherothrombosis1
Normal platelets
in flowing blood
Platelets adhering to
damaged endothelium
and undergoing activation
Aggregation
of platelets into
a thrombus
Platelet
thrombus
Platelets
Platelets adhering to
subendothelial space
Endothelial cells
Subendothelial space
1. Adapted from: Ferguson JJ. In: Ferguson JJ, Chronos N, Harrington RA (Eds).
Antiplatelet Therapy in Clinical Practice. London: Martin Dunitz; 2000: 15–35.
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Major Manifestations of Atherothrombosis1
Cerebrovascular disease
(Cerebrovasc Dis)
Coronary artery disease (CAD)
Peripheral arterial disease (PAD)
1. Viles-Gonzalez JF. Eur Heart J 2004; 25: 1197–1207.
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Cardiovascular Disease is the Leading Cause of
Death Worldwide1
HIV/AIDS
5
Pulmonary disease
7
Injuries
9
Cancer
13
Infectious and
parasitic diseases
19
Cardiovascular disease*
29
0
5
10
15
20
Percentage of total deaths in 2002
25
30
*Ischemic heart disease, cerebrovascular disease, hypertensive heart
disease, inflammatory heart disease and rheumatic heart disease
1. The World Health Report 2004. WHO Geneva, 2004.
Available at: http://www.who.int/whr/2004/en/. Accessed January 2006.
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Atherothrombosis Significantly Shortens Life
Expectancy1
Analysis of data from the Framingham Heart Study:
Average remaining life expectancy for males aged 60 years
7.7 years
20
9.2 years
12.0 years
History of any History of
cardiovascular acute MI
disease*
History of
stroke
Time (years)
16
12
8
4
0
Healthy
*Including coronary heart disease, cerebrovascular accident, congestive heart failure and intermittent claudication
1. Peeters A et al. Eur Heart J 2002; 23: 458466.
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Risk of Atherothrombosis
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Atherothrombosis is Often Found in More Than
One Arterial Bed*1
Cardiovascular
disease
Cerebrovascular
disease
24.7%
7.4%
29.9%
26.2%†
3.3%
3.8%
11.8%
19.2%
PAD
A total of ~26% of patients
had manifestations of
atherothrombosis in
more than one arterial bed
*Data from the Clopidogrel versus Aspirin in Patients at
Risk of Ischemic Events (CAPRIE) study (n=19,185)
†Total does not add up because of rounding
1. Coccheri S. Eur Heart J 1998; 19(Suppl): 227.
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Patients with Previous Atherothrombotic Events
are at Increased Risk of Further Events
Increased risk versus general population
MI
Stroke
Ischemic stroke
2–3 X
(includes angina and
sudden death*)1
9 X2
MI
5–7 X
(includes death)3
3–4 X
(includes TIA)1
PAD
4X
(includes only fatal MI and
other CHD death†)4
2–3 X
(includes TIA)2
*Sudden death defined as death documented within one hour and attributed to
coronary heart disease (CHD)
†Includes only fatal MI and other CHD death; does not include non-fatal MI
1.
2.
3.
4.
Kannel WB. J Cardiovasc Risk 1994; 1: 333–339.
Wilterdink JI et al. Arch Neurol 1992; 49: 857–863.
Adult Treatment Panel II. Circulation 1994; 89: 1333–1363.
Criqui MH et al. N Engl J Med 1992; 326: 381–386.
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Risk Factors can Create High Risk of MI and
Stroke, Even With No History of These Events1
Independent risk factors:
• Male aged 65 years
or female aged 70
years
• Current smoking
>15 cigarettes/day
• Type 1 or 2
diabetes
• Hypercholesterolemia
• Diabetic nephropathy
• Hypertension
• ABI <0.9 in either
leg at rest
• Asymptomatic carotid
stenosis 70%
• Presence of at least
one carotid plaque
1. Bhatt DL et al. Am Heart J 2004; 140: 263–268.
Increased risk of
atherothrombotic events
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Risk of CHD Increased in Patients with Multiple
Risk Factors1
70
Men
Women
60
50
40
30
20
10
0
0
1
2
3
4
5
6
Number of risk factors*
*Risk factors: hypertension; hypercholesterolemia;
dyslipidemia; diabetes; smoking; left ventricular hypertrophy
1. Kannel WB. Hypertens Res 1995; 18: 181–196.
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Many Risk Factors are Easily Identified1,2
Risk factor
Monitoring method
Diabetes
Fasting blood glucose levels
Low ABI
ABI measurement
Carotid artery intima-media
thickness (IMT)
Doppler ultrasonography
Hypertension
Blood pressure
Hypercholesterolemia
Cholesterol testing
Microalbuminuria
Urine albumin concentrations
Weight
Body mass index (BMI)
1. Grundy SM. Am J Cardiol 2001; 88(Suppl): 8E11E.
2. Ferdinand KC et al. Curr Med Res Opin 2005; 21: 10911097.
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REACH Registry: Background
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REACH Registry:
Rationale and Objectives
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REACH Registry: a Global Observational Study
of around 68,000 Patients in 44 Countries Who
Are at High Risk of Atherothrombosis1
Rationale
• Evaluation of atherothrombosis is still limited because
previous surveys have:
1. Focused on studying specific risk factors, or ‘single’
manifestations of the disease (e.g. heart disease)
2. Focused mostly on hospitalized or hospital-treated patients
with stringent inclusion criteria
3. Been conducted in either North America or Europe
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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REACH Registry: a Global Observational Study
of around 68,000 Patients in 44 Countries Who
Are at High Risk of Atherothrombosis1
The REACH Registry should have these added advantages:
• The most globally inclusive and geographically extensive
registry of patients at high risk of heart attack and stroke
• Includes a broad spectrum of patient types – with or without a
previous history of disease
• Provides data from a ‘real world’ setting, reflecting daily
practice
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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REACH Registry: Objectives1
Primary objectives are:
Compile international data set
to extend knowledge of
atherothrombotic risk factors
and ischemic events in the
outpatient setting
Provide a better understanding
of the prevalence and clinical
consequences of
atherothrombosis in a wide
range of patients from different
parts of the world
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
Important intermediate
investigations have included:
Assess use of risk management
strategies and 18- to 24-month
outcomes in a broad outpatient
population encompassing
various geographic regions and
physician specialties
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Improving the Management of Cardiovascular
Disease Risk
Guideline recommendations by which REACH Registry patients are benchmarked
Risk factor
Recommendation
Blood pressure
<140/90 mm Hg1,2 (<130/80 mm Hg for patients with diabetes13)
Total cholesterol
<200 mg/dL/<11.1 mmol/L1–4
Triglyceride
<150 mg/dL (<1.7 mmol/L)3,4
Diabetes
management
Normal fasting plasma glucose (<110 mg/dL [<6.0 mmol/L])1,2 and
near-normal HbA1c levels (≤6.1%2 or <7.0%1,3)
Smoking
Complete cessation13
Dietary intake
An overall healthy eating pattern13
Physical activity
Moderate intensity physical activity for 3045 minutes at least 35
times per week13
Weight
management
Achieve and maintain desirable weight14 (BMI 18.5–24.9 kg/m2).1
When BMI is ≥25 kg/m2, waist circumference at iliac crest level ≤102
cm (≤40 inches) in men and ≤88 cm (≤35 inches) in women1,2
1. Pearson TA et al. Circulation 2002; 106: 388391.
2. De Backer G et al. Eur Heart J 2003; 24: 16011610.
3. American Diabetes Association. Diabetes Care 2005; 28: S4S36.
4. Adult Treatment Panel III. National Institutes of Health,
Publication No. 02-5215, September 2002.
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What do we hope the REACH Registry will
achieve?
REACH is the most geographically and ethnically diverse
atherothrombotic population yet surveyed, providing the most accurate
view to date of burden of disease and long-term prognosis for patients at
high risk for atherothrombotic events
With up to four years of clinical follow-up, the REACH Registry will
 provide long-term insights into real-world event rates, treatment
patterns and outcomes
 help to improve assessment and management of stroke, heart
attack and associated risk factors
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REACH Registry: Design
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REACH Registry Timeline
Baseline
Follow-up at 12
 3 months
Follow-up at 24
 3 months
REACH Registry
extension
REACH Registry
extension
Timing*
Dec 2003 to
June 2004
From baseline
time
Last follow-up
March 2006
Sept 2006 to
March 2007
Sept 2007 to
March 2008
Required
Data
Subject Data
Form:
Section 1
Subject Data
Form: Section 2
(progression
since baseline)
Subject Data
Form: Section 3
(progression
since last
follow-up)
Subject Data
Form: Section 4
(progression
since last
follow-up)
Subject Data
Form: Section 5
(progression
since last
follow-up)
Patient details,
history and
clinical
examination
Regular
medications
Employment
status
Clinical outcomes
Vascular interventions
Regular medications
Employment status
*Timelines are for worldwide participation; local timelines will be shorter
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REACH Registry Inclusion Criteria1
Must include:
Signed
written
informed
consent
Patients aged
≥45 years
1. Documented
cerebrovascular disease
Ischemic stroke or TIA
2. Documented
coronary disease
Angina, MI, angioplasty/
stent/bypass
1
2. Current smoking
>15 cigarettes/day
3. Type 1 or 2
diabetes
4. Hypercholesterolemia
3. Documented historical
or current intermittent
claudication associated
with ABI <0.9
4.
At least
of four
criteria
1. Male aged 65 years
or female aged 70
years
At least
atherothrombotic
risk factors
3
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
5. Diabetic nephropathy
6. Hypertension
7. ABI <0.9 in either
leg at rest
8. Asymptomatic carotid
stenosis 70%
9. Presence of at least
one carotid plaque
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REACH Registry Exclusion Criteria1
• Anticipated difficulty in patient returning for follow-up visit
• Patient is currently hospitalized
• Patient is currently participating in a clinical trial
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
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Physician Selection: Reflection of Each
Country’s Management of Cardiovascular Risk1
Participating physicians
How were they
selected?
Pre-defined at start of Registry
Based on local practice population
• General practitioners (GPs), specialists
Mainly office-based, some hospital representation
What is their
profile?
Representative of:
• Local environment
• Country geography
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
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Patient Selection: Patients Fitting Inclusion
Criteria1
Patients
How were they
selected?
Recruitment at each site
Maximum per site determined at local level (subject to
central guidelines)
Within overall Registry timelines
What is their
profile?
Patient inclusion criteria
• Documented atherothrombotic disease, or with at least 3
atherothrombotic risk factors
Real-life setting
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
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REACH Registry:
Baseline Results
Data shown may differ slightly from published abstracts
owing to a subsequent database lock
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Aims of the Baseline Analysis1
Aim:
• To determine whether atherosclerosis risk factor prevalence
and treatment would demonstrate comparable patterns in many
countries around the world
Conclusion:
• Classic cardiovascular risk factors are consistent and common,
but are largely undertreated and undercontrolled in many
regions of the world
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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REACH Registry: Conclusions From Baseline
Cardiovascular risk profiles are common and consistent across different
geographic locations and patient types:1
• Treatment goals are consistently not achieved in all patient types
worldwide
• Established therapies are consistently underused in high-risk
populations
• Women are undertreated despite commonly having more severe
disease2
The REACH Registry patients with PAD have:3
• A high prevalence of concomitant disease in other vascular beds
• Multiple risk factors for atherothrombosis, including pre-diabetes and
undiagnosed diabetes
• Underutilization of appropriate medications to treat cardiovascular risk
The REACH Registry patients with cerebrovascular disease have:4
• A high prevalence of multiple risk factors for atherothrombosis and
disease in other vascular beds
• Underutilization of appropriate medications
1. Bhatt DL et al, on behalf of the REACH Registry Investigators. JAMA 2006; 295(2):180-189.
2. Steg PG et al. Eur Heart J 2005; 26(Suppl): Abstract 1642.
3. Bhatt DL et al. J Am Coll Cardiol 2005; 45(3 Suppl): Abstract 1127–1196.
Updated slide kit, February 2006
4. Röther J et al. International Stroke Conference 2005; late breaking abstract.
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A Large and Far-Reaching International Survey
of Atherothrombosis*1
Europe: 23,542
Austria: 1,588
Belgium: 383
Bulgaria: 996
Lithuania: 99
The Netherlands: 324
Portugal: 218
Denmark: 422
Romania: 2,009
North America: 27,746
Finland: 311
Russia: 999
Canada: 1,976
USA: 25,770
France: 4,592
Spain: 2,515
Germany: 5,521
Switzerland: 695
Greece: 699
Ukraine: 596
Hungary: 957
United Kingdom: 618
Asia: 10,951
China: 708
Hong Kong: 175
Indonesia: 499
Japan: 5,048
Malaysia: 525
Philippines: 1,039
Singapore: 880
South Korea: 505
Taiwan: 1,057
Thailand: 515
Latin America: 1,931
Brazil: 441
Chile: 253
Mexico: 899
Interlatina†: 338
Middle East: 846
Israel: 379
Kingdom of Saudi Arabia: 198
Lebanon: 120
United Arab Emirates: 149
Australia: 2,872
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
†Interlatina
includes Panama, Costa Rica, Dominican Republic, Ecuador, Guatemala and Peru
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Broad Geographic Representation*1
Geographic location of patients included in the initial analysis1
34.6%
40.8%
16.3%
North America
Europe
Asia (incl. Japan)
Australia
Latin America
Middle East
1.2% 2.8% 4.2%
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
Updated slide kit, February 2006
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Age and Gender of the Symptomatic Baseline
Population*1
100
80
Mean age (years)
Male (%)
Age and Gender, Symptomatic Population
(years, % of symptomatic population)1
70
62
67 65
68
74
72
63
67
66
65 67
73
66
70
74
60
40
20
0
North
America
(n=20,750)
Latin
America
(n=1,681)
Western
Europe
(n=15,053)
Eastern
Europe
(n=5,375)
Middle
East
(n=718)
Asia
(n=5,137)
Australia
(n=2,567)
Japan
(n=4,218)
*Symptomatic refers to patients with documented CAD, Cerebrovasc Dis and/or PAD; data shown
may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Classic Cardiovascular Risk Factors are
Consistent and Common within the Symptomatic
REACH Registry Baseline Population*1
100
Risk Factor Prevalence, Symptomatic Population
(% of symptomatic population)1
85
84 82
80
80
76
72
56
51
43
38
78
71
59
60
40
81 81
78
77
Diabetes (%)
Hypertension (%)
Hypercholesterolemia (%)
49
45
41
39
34
26
25
20
0
North
Latin
Western
Eastern
Middle
Asia
Australia
Japan
America
America
Europe
Europe
East
(n=5,137) (n=2,567) (n=4,218)
(n=20,750) (n=1,681) (n=15,053) (n=5,375)
(n=718)
*Symptomatic refers to patients with documented Coronary artery, Cerebro and/or Peripheral
Arterial Disease; data shown may differ slightly from published abstracts owing to a subsequent
database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Age and Gender of the Multiple Risk Factor
Population at Baseline*1
100
80
Age and Gender, Multiple Risk Factor Population
(years, % of MRF population)1
69
69
66
68
65
61
56
60
47
67
50
44
41
Mean age (years)
Male (%)
73
70
55
49
40
20
0
North
America
(n=6,996)
Latin
America
(n=250)
Western
Europe
(n=2,833)
Eastern
Europe
(n=281)
Middle
East
(n=128)
Asia
(n=766)
Australia
(n=305)
Japan
(n=830)
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Classic Cardiovascular Risk factors are
Consistent and Common within the Multiple Risk
Factor REACH Registry Baseline Population*1
Risk Factor Prevalence, Multiple Risk Factor Population
(% of MRF population)1
Diabetes (% )
Hypertension (% )
120
Hypercholesterolemia (% )
100
80
93
77
80
94
94
92
89
89
87
77
71
77
70
60
94
87 88
68
84 83
87
73
71
65
53
40
20
0
North
America
(n=6,996)
Latin
America
(n=250)
Western
Europe
(n=2,833)
Eastern
Europe
(n=281)
Middle
East
(n=128)
Asia
(n=766)
Australia
(n=305)
Japan
(n=830)
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Primary Care Practitioners (GPs and internists)
Formed the Majority of REACH Registry
investigators
REACH Registry Investigators by specialty (% of total)1
29%
43%
13%
General practitioners
Internists
Cardiologists
Neurologists
Angiologists
General surgeons
Endocrinologists
Other expertise
9%
1%
2% 2%
1%
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Ohman EM et al, on behalf of the REACH Registry Investigators.
Am Heart J 2006; in press.
Updated slide kit, February 2006
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High Prevalence of Polyvascular Disease
(Disease in More Than One Arterial Bed)
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~ 1/4 of Patients with CAD
Have Polyvascular Disease1
~ 1/4 of the 40,258 patients with CAD also have atherothrombotic
disease in other arterial territories
(%s are of total population)1
RISK FACTORS
ONLY
Patients with CAD =
59.3% of the REACH
Registry population
Coronary
Artery Dis
44.6%
8.4%
1.6%
4.7%
Cerebrovascular
Periph Art
Disease
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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~ 2/5 of Patients with Cerebrovascular Disease
Have Polyvascular Disease1
~ 2/5 of the 18,843 patients with Cerebrovascular Disease also have
atherothrombotic disease in other arterial territories
(%s are of total population)1
RISK FACTORS
ONLY
Coronary
Artery Dis
Patients with
Cerebrovasc Dis =
27.8% of the REACH
Registry population
8.4%
1.6%
Cerebrovascular
16.6%
1.2%
Periph Art
Disease
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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~ 3/5 of Patients with Symptomatic PAD
Have Polyvascular Disease1
~ 3/5 of the 8,273 patients with PAD also have
atherothrombotic disease in other arterial territories
(%s are of total population)1
RISK FACTORS
ONLY
Patients with PAD =
12.2% of the total
REACH Registry
population
Coronary
Artery Dis
1.6%
4.7%
Cerebrovascular
1.2%
Periph Art
Disease 4.7%
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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A Large Minority had Polyvascular Disease in
the REACH Registry*1
Prevalence of disease in arterial beds
(% of total)1
Single Arterial Bed
Overall
65.9
44.6
CAD Alone
16.6
Cerebro Alone
PAD Alone
4.7
Polyvascular Disease
Overall
15.9
8.4
CAD + Cerebro
4.7
CAD + PAD
Cerebro + PAD
1.2
1.6
CAD + Cerebro + PAD
Multiple Risk Factors
18.3
0
10
20
30
40
50
60
70
Patients (%)
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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Undertreatment of Patients with
Atherothrombosis Worldwide
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Patients not achieving target (%)
Undertreatment of Risk Factors
in Patients Worldwide*1
Patients not achieving target
(% of regional population)1
100
North America
Latin America
Western Europe
Eastern Europe
Middle East
Asia
Australia
Japan
80
60
60
53
40
65
64
56
52 56
48
44
43
43
40
43
34
28
24
17
15
20
9
21
15
17
13
7
0
Elevated blood
pressure (≥140/90 mm
Hg)
Elevated cholesterol
(≥200 mg/dL)
Continued smoking (≥5
cigarettes/d)
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
46
Established Therapies are Consistently
Underused in All Patient Types*1
Patients not receiving proven therapy (%)
Patients not receiving therapy
(% of subpopulation)1
60
Antiplatelets
50
Statin
46
44
39
40
36
30
30
20
Lipid-lowering
28
24
19
18
19
18
14
10
0
CAD (n=40,258)
Cerebrovasc Dis
(n=18,843)
PAD (n=8,273)
Multiple Risk
Factors (n=12,389)
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
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High Prevalence of Overweight and Obesity in
Most Regions*1
Variation of overweight and obesity in the symptomatic population**
(% of regional population)1
100%
90%
Percent of population
80%
70%
BMI <25
BMI 25-<30
BMI 30-<35
BMI 35-<40
BMI ≥40
60%
50%
40%
30%
20%
10%
0%
North
Latin
Western Eastern
America America Europe Europe
Middle
East
Asia
Australia
Japan
*Data shown may differ slightly from published abstracts owing to a subsequent database lock;
**Symptomatic refers to patients with documented CAD, Cerebrovasc Dis and/or PAD
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
Updated slide kit, February 2006
JAMA 2006; 295(2): 180-189.
48
Overweight and Obesity Highly Prevalent in
Multiple Risk Factor Patients in Most Regions*1
100%
Variation of Overweight and Obesity in the
Multiple Risk Factor REACH Registry Population
(% of regional population)1
90%
Percent of population
80%
70%
BMI <25
BMI 25-<30
BMI 30-<35
BMI 35-<40
BMI ≥40
60%
50%
40%
30%
20%
10%
0%
North
Latin
Western Eastern
America America Europe Europe
Middle
East
Asia
Australia
Japan
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
49
High Prevalence of Concomitant Risk Factors in
Patients with Symptomatic PAD*1
Patients† (%)
100
Prevalence of risk factors in the PAD population
(% of subpopulation)1
81.0
80
66.7
60
44.2
40
24.5
20
0
Diabetes
Hypercholesterolemia
Current smoker
Hypertension
†Of
the 8,273 patients with symptomatic PAD, the mean age was 69.2 years
and 70.7% were male
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
50
Patients receiving proven therapy (%)
PAD Patients are Less Likely than Other
Patients to Use Established Therapies*1
Patients receiving established therapy
(% of patients)1
100
97.4
94.1
92.4
85.6
81.8
81.7
82.5
82.2
85.6
80.9
80
70.0
61.3
60
40
20
0
Antihypertensives
CAD only population
Antiplatelets
Oral antidiabetic
agents
CVD only population
Lipid-lowering
therapy
PAD only population
For antihypertensives, % is of pts diagnosed hypertension or elevated blood pressure at initial examination;
For oral antidiabetics, % is of pts with history of diabetes or elevated blood glucose at initial examination
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
51
Risk factors are consistently found across all
disease sub-populations*1
Risk Factor Prevalence, By Sub-Population
(% of MRF population)1
100
80.3
83.3 81
80
CAD only population
CVD only population
PAD only population
77
Patients (%)
66.7
58.2
60
44.2
38.3 37.4
40
29.9
24.5
23.7 23.8
20
13
14.3
0
Treated
hypertension
Treated hyper- Treated diabetes Obesity (BMI ≥30) Current smoker
cholesterolemia
*Data shown may differ slightly from published abstracts owing to a subsequent database lock.
1. Bhatt DL et al, on behalf of the REACH Registry Investigators.
JAMA 2006; 295(2): 180-189.
Updated slide kit, February 2006
52
REACH Registry:
Today and Beyond
Updated slide kit, February 2006
53
Publications to Date
Updated slide kit, February 2006
REACH Registry Publications  Abstracts (I)
Title
Lead
author
Citation/conference
Undertreatment of atherothrombotic patients
worldwide: baseline data from the REACH Registry
Steg PG
J Am Coll Cardiol 2005;
45(3 Suppl): Abstract 1070–
121
Risk profile and undertreatment of peripheral arterial
disease  7,013 patients from the international
REACH Registry
Bhatt D
J Am Coll Cardiol 2005;
45(3 Suppl): Abstract 1127–
1196
Worldwide data from 15,332 stroke patients in 2004 
the REACH Registry
Röther J
International Stroke
Conference 2005; late
breaking abstract
Secondary prevention and undertreatment in 16,901
cerebrovascular patients worldwide: data from the
REACH Registry
Röther J
Cerebrovasc Dis 2005;
19(Suppl 2): Abstract
Undertreatment of women with atherothrombosis:
results from the worldwide REACH Registry
Steg PG
Eur Heart J 2005;
26(Suppl): Abstract 1642
54
Correct as of 16th February 2006
Updated slide kit, February 2006
REACH Registry Publications  Abstracts (II)
Title
Lead
author
Citation/conference
The prevalence of obesity in the international REACH
Registry - a truly global epidemic with the United
States leading the world
Bhatt D
Eur Heart J 2005;
26(Suppl): Abstract 3925
Attained educational level, hypertension and
hypercholesterolemia in persons with
atherothrombosis: the experience of >48,000 patients
from the international REACH Registry
Wilson PW
Eur Heart J 2005;
26(Suppl): Abstract 447
Comparison of risk factors between stroke and
transient ischemic attack patients: observations from
the international REACH Registry
Röther J
World Congress of
Neurology 2005 oral
presentation
Renal insufficiency is frequent and undertreated
among outpatients at high risk of atherothrombotic
events: lessons from the REACH Registry
Dumaine R
AHA 2005 oral
presentation
Quality of secondary prevention: a comparison
between stroke and transient ischemic attack (TIA)
patients
Röther J
AHA-Stroke 2006 poster
presentation
55
Correct as of 16th February 2006
Updated slide kit, February 2006
56
REACH Registry Publications  Papers
Title
Lead
author
Citation
Atherothrombosis and stroke - a lot more to know!
Röther J
Cerebrovasc Dis
2005;20(2):139-40
Estimating the risk for atherothrombosis – are current
algorithms sufficient?
Wilson P
Eur J Cardiovasc Prev
Rehabil 2005;12(5):427-32
The REduction of Atherothrombosis for Continued
Health (REACH) Registry: An international,
prospective, observational investigation in subjects at
risk for atherothrombotic events – study design
Ohman EM
Am Heart J 2006; In Press
International prevalence, recognition, and treatment of
cardiovascular risk factors in outpatients with
atherothrombosis
Bhatt D
JAMA 2006;295(2):180-9
Correct as of 16th February 2006
Updated slide kit, February 2006
57
Upcoming Analyses and Data Availability
Preliminary 1-year results from participating countries
are available at: www.REACHRegistry.org
Updated slide kit, February 2006
58
Main Outcomes as Registry Continues
Timing
Baseline
Follow-up at 12
 3 months
Follow-up at 24
 3 months
REACH Registry
extension
REACH Registry
extension
Dec 2003 to
June 2004
From baseline
time
Last follow-up
March 2006
Sept 2006 to
March 2007
Sept 2007 to
March 2008
Forthcoming analyses will examine:
• Combined endpoint of cardiovascular death, nonfatal stroke, nonfatal
MI, vascular interventions and hospitalizations for atherothrombotic
events
• Combined endpoint of nonfatal stroke, nonfatal MI and cardiovascular
death
• Individual outcomes of cardiovascular death, fatal or nonfatal MI, fatal
or nonfatal stroke, all-cause death, vascular interventions,
hospitalizations for ischemic events and hospitalizations for causes
other then ischemia
Updated slide kit, February 2006
59
Accepted Abstracts
Title
Lead
author
Conference/Type
Cannon C
ACC 2006
Oral presentation
REduction in Atherothrombosis for Continued
Health (REACH) Registry results: 1-year
cardiovascular event rates in a global
contemporary registry of over 68,000 outpatients
with atherothrombosis
Steg PG
ACC 2006
Late-breaker
"Global" Risk Factors and Treatment Intensity in
Elderly Patients with Atherosclerosis: The
Experience of the International REACH Registry
Hirsch AT
ACC 2006
Poster
Risk factor control among patients with diabetes
mellitus in Europe and the rest of the world: the
experience of the REACH Registry
Wilson
PW
CVDEP 2006 (AHA-Epi 2006)
Poster
Better Guideline Compliance with Medical Therapy
seen in Patients with Prior Coronary
Revascularization : Results from the REduction of
Atherothrombosis for Continued Health (REACH)
Registry
Correct as of 16th February 2006
Updated slide kit, February 2006
60
Papers in Development (I)
Title
Lead author
Target journal
Steg PG
JAMA
Risk factor profile and management of 18,984 patients
in 2004, the REACH Registry - an international
prospective observational registry in subjects at risk
of atherothrombotic events in an outpatient setting
Roether J,
Mas J-L
Stroke TBC
Risk of vascular death and myocardial infarction in
patients with stroke or TIA: Results from the
REduction of Atherothrombosis for Continued Health
(REACH) Registry
Mas J-L
TBC
Dumaine R,
Montalescot G,
YeoT-C, Chan J
TBC
Hirsch AT
TBC
1-Year Cardiovascular Event Rates in the REACH
Registry International Cohort of Over 68,000 Stable
Outpatients with Atherothrombosis
Renal insufficiency according to atherothrombosis
location in the REACH Registry
The international morbidity and mortality of peripheral
arterial disease: Insights from the REACH Registry
Correct as of 16th February 2006
Updated slide kit, February 2006
61
Papers in Development (II)
Title
Lead author
Target journal
Socio-economic status baseline article
Wilson PWF
TBC
Analysis of the intensity of prevention efforts (at
baseline) in CAD patients
Cannon C
TBC
CABG manuscript
Ohman EM
TBC
Baumgartner I
TBC
Eagle K
TBC
hs-CRP in CAD
Cannon C,
Zeymer U
TBC
Cardiovascular morbidity of severe peripheral arterial
disease: the fate of individuals with ischemic
amputations in the REACH Registry
Abola MTB
TBC
Baseline control of risk factors according to surgical
or medical management of PAD patients in the REACH
Registry
Cacoub P
TBC
The risk of abdominal aortic aneurysms: The REACH
Registry
1-year outcomes in CAD patients
Correct as of 16th February 2006
Updated slide kit, February 2006
62
Participating Organizations and Scientific
Committees
Updated slide kit, February 2006
63
Scientific Committee1
Name
Affiliation
P Gabriel Steg, MD
Hôpital Bichat-Claude Bernard, Paris, France (Co-chair)
Deepak L Bhatt, MD
Cleveland Clinic Foundation, Cleveland, OH, USA (Co-chair)
E Magnus Ohman, MD
Duke University Medical Center, Durham, NC, USA
Joachim Röther, MD,
PhD
Klinikum Minden, Minden, Germany
Peter WF Wilson, MD
Medical University of South Carolina, Charleston, SC, USA
1. REACH Registry website. Available at: http://www.REACHRegistry.org.
Accessed January 2006.
Updated slide kit, February 2006
64
Publication Committee1
Name
Affiliation
Deepak L Bhatt, MD
Cleveland Clinic Foundation, Cleveland, OH, USA
Shinya Goto, MD,
DMedSci
Tokai University School of Medicine, Kanagawa, Japan
Alan T Hirsch, MD
University of Minnesota School of Public Health, Minneapolis,
MN, USA
Chiau-Suong Liau, MD,
PhD
Taiwan University Hospital and College of Medicine, Taipei,
Taiwan
Jean-Louis Mas, MD
Centre Raymond Garcin, Paris, France
E Magnus Ohman, MD
Duke University, Durham, SC, USA
Joachim Röther, MD,
PhD
Klinikum Minden, Minden, Germany
P Gabriel Steg, MD
Hôpital Bichat-Claude Bernard, Paris, France
Peter WF Wilson, MD
Medical University of South Carolina, Charleston, SC, USA
Ralph D’Agostino, PhD
Boston University, Boston, MA, USA
1. REACH Registry website. Available at: http://www.REACHRegistry.org.
Accessed January 2006.
Updated slide kit, February 2006
65
National Coordinators (I)1
Country
Name and affiliation
Australia
Christopher Reid, Monash University, Victoria
Austria
Franz Aichner, Landes-Nervenklinik Wagner-Jauregg, Linz
Thomas Wascher, Medizinische Universitätsklinik, Graz
Belgium
Patrice Laloux, Cliniques Universitaires UCL, Mont-Godinne
Brazil
Denilson Campos de Albuquerque, State University of Rio de Janeiro, Rio de Janeiro
Bulgaria
Julia Djorgova, University Hospital St Ekaterina, Sofia
Canada
Eric A Cohen, Sunnybrook & Women’s College Health Sciences Center, Toronto, Ontario
Chile
Ramon Corbalan, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago
China
Chuanzhen LV, Shanghai Huashan Hospital, Shanghai
Runlin Gao, Fu Wai Hospital, Beijing
Denmark
Per Hildebrandt, H.S. Frederiksberg Hospital, Frederiksberg
Finland
Ilkka Tierala, Helsinki University Hospital, Helsinki
France
Jean-Louis Mas, Hôpital Saint-Anne, Paris
Patrice Cacoub, Groupe Hospitalier Universitaire Pitié Salpétrière, Paris
Gilles Montalescot, Groupe Hospitalier Universitaire Pitié Salpétrière, Paris
Germany
Klaus Parhofer, Universitätsklinikum Großhadern, Munich
Uwe Zeymer, Klinikum Ludwigshafen Medizinische, Ludwigshafen
Joachim Röther, Klinikum Minden, Minden
1. REACH Registry website. Available at: http://www.REACHRegistry.org.
Accessed January 2006.
Updated slide kit, February 2006
66
National Coordinators (II)1
Country
Name and affiliation
Greece
Moses Elisaf, University of Ioannina Medical School, Ioannina
Guatemala
Romulo López, Centro Diagnostico, Cuidad de Guatemala
Hong Kong
Juliana Chan, Prince of Wales Hospital, Shatin
Hungary
György Pfliegler, University of Debrecen Medical and Health Science Center, Debrecen
Indonesia
Bambang Sutrisna, University of Indonesia, Jakarta
Israel
Avi Porath, Soroka Medical Center, Beer Sheva
Japan
Yasou Ikeda, Keio University School of Medicine, Tokyo
Lebanon
Ismail Khalil, American University Hospital Hamra, Beirut
Lithuania
Ruta Babarskiene, University Hospital, Kaunas
Malaysia
Robaayah Zambahari, Institut Jantung Negara, Kuala Lumpur
Mexico
Efrain Gaxiola, Instituto Cardiovascular de Guadalajara, Jalisco
The Netherlands
Don Poldermans, Erasmus Medisch Centrum, Rotterdam
Philippines
M. Teresa B. Abola, Philippine Heart Center, Quezon City
Portugal
Victor Gil, Hospital Fernando Fonseca, Amadora
Romania
Constantin Popa, Institutul de Boli Cerebro-Vasculare, Bucharest
Russia
Yuri Belenkov, Cardiology Research Complex, Moscow
Elizaveta Panchenko, Cardiology Research Complex, Moscow
1. REACH Registry website. Available at: http://www.REACHRegistry.org.
Accessed January 2006.
Updated slide kit, February 2006
67
National Coordinators (III)1
Country
Name and affiliation
Saudi Arabia
Hassan Chamsi-Pasha, King Fahd Military Hospital, Jeddah
Singapore
Yeo Tiong Cheng, National University Hospital, Singapore
South Korea
Oh Dong-Joo, Korea Hospital, Seoul
Spain
Carmen Suárez, Hospital Universitario de la Princesa, Madrid
Switzerland
Iris Baumgartner, Universitätspital Bern, Bern
Taiwan
Chiau-Suong Liau, National Taiwan University Hospital, Taipei
Thailand
Piyamitr Sritara, Ramathibodi Hospital, Bangkok
United Arab
Emirates
Wael Mahameed, Al Jazeera Hospital, Abu Dhabi
UK
Jonathan Morrell, The Conquest Hospital, Hastings
Ukraine
Vira Tseluyko, Kharkov Medical Academy of Postgraduate Education, Kharkov
USA
Mark Alberts, Northwestern University Medical Center, Chicago, IL
Robert M. Califf, Duke University Medical Center, Durham, NC
Christopher P. Cannon, Brigham and Women’s Hospital, Boston, MA
Kim Eagle, University of Michigan Cardiovascular Center, Ann Arbor, MI
Alan T Hirsch, Minneapolis Heart Institute Foundation and Division of Epidemiology and
Community Health, University of Minnesota School of Public Health, Minneapolis, MN
1. REACH Registry website. Available at: http://www.REACHRegistry.org.
Accessed January 2006.
Updated slide kit, February 2006
68
Participating Organizations
The REACH Registry is sponsored jointly by
Updated slide kit, February 2006
69
REACH Registry: Further Information
For further information on the REACH
Registry go to:
http://www.REACHRegistry.org
Updated slide kit, February 2006