Cardiovascular risk profile and outcome of patients with abdominal aortic aneurysm in out-patients with atherothrombosis: Data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry
Received 14 January 2008; accepted 8 May 2008. published online 18 July 2008.
Objective
Datasets regarding patients with abdominal aortic aneurysm (AAA) have almost universally been restricted to single geographic regions. We aimed to obtain data on the risk factor profile and cardiovascular (CV) co-morbidity among multi-ethnic patients with known AAA in the global REACH (REduction of Atherothrombosis for Continued Health) Registry.
Methods
The REACH Registry is an international, prospective, observational out-patient registry enrolling out-patients ≥45 years of age with established coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral arterial disease (PAD) or with at least three atherothrombotic risk factors. This report includes observations pertaining to 68,236 out-patients enrolled in 44 countries.
Main outcome measures
Gender, ethnic origin, CV risk factors, established atherosclerotic disease (CAD, CVD and PAD) at baseline, and CV outcome events at 1-year were compared in patients with and without AAA.
Results
An AAA was reported in 1722 (2.5%) of 68,236 out-patients enrolled in the REACH Registry. Older age (73 ± 8 vs 68 ± 10, P < .0001), male gender (81% vs 63%, P < .0001), White ethnicity (79% vs 67%, P < .0001) and a history of smoking (81% vs 55%, P < .0001) were independently related to the diagnosis of AAA. There was a weaker association with hypertension or hypercholesterolemia, and an inverse relation with diabetes. Fatal and non-fatal coronary and cerebrovascular event rates were not different between the AAA and non-AAA cohorts, but individuals with AAA suffered increased rates of other cardiovascular deaths (1.39% vs 0.94%, P = .0135), hospitalizations for atherothrombotic events (14.1% vs 9.3%, P < .0001) due to increased rates of revascularization procedures, and new or worsening PAD (3.7% vs 1.3%, P < .0001) at 1-year follow-up.
Conclusion
This study, the largest published to date, presents the CV risk profile and outcome of patients with an established diagnosis of AAA from a cohort of patients with either overt manifestations of CV disease or multiple risk factors, and further defines these patients in a multi-ethnic, global context.
aDepartment of Clinical and Interventional Angiology, Swiss Cardiovascular Centre, Angiology Division, University Hospital, Bern, Switzerland
bVascular Medicine Program, Division of Epidemiology and Community Health, University of Minnesota School of Public Health and Minneapolis Heart Institute Foundation, Minneapolis, Minn
cVascular Medicine Section, Division of Clinical Cardiology, Department of Cardiovascular Medicine, Philippine Heart Center, Quezon City, Philippines
dPierre and Marie Curie Université, and Hôpital La Pitié-Salpêtrière, Paris, France
eErasmus Medical Center, Rotterdam, The Netherlands
fINSERM U-698 and APHP (Hôpital Bichat-Claude Bernard), Université Paris 7, Paris, France
gBrigham and Women's Hospital and Harvard Medical School, Boston, Mass
Reprint requests: Professor I. Baumgartner, Head, Clinical and Interventional Angiology, Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland
The REACH Registry is sponsored by Sanofi-Aventis and Bristol-Myers Squibb, and sponsored by the Waksman Foundation in Japan.
Competition of interest: none.
Additional material for this article may be found online at www.jvascsurg.org.
ABSTRACT