Effects of Adherence to Guidelines for the Control of Major Cardiovascular Risk Factors on Outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe

Study Questions:

What is the impact of cardiovascular risk factor control on 3-year cardiovascular event rates in patients with stable symptomatic atherothrombotic disease in Europe?

Methods:

The REduction of Atherothrombosis for Continued Health (REACH) Registry recruited patients ages ≥45 years with established atherothrombotic disease or three or more risk factors. This study included 20,588 symptomatic patients from 18 European countries evaluated at baseline and 12, 24, and 36 months. “Good control” of cardiovascular risk factors was defined as 3-5 risk factors at target values of international guideline recommendations (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg, fasting glycemia <110 mg/dl, total cholesterol <200 mg/dl, nonsmoking). Independent predictors of “good control” of major risk factors were assessed by multivariate analysis.

Results:

Among symptomatic patients in the REACH Registry Europe (mean age 67 years, 70.6% male), 59.4% had good control of risk factors at baseline. Fatal and nonfatal events were higher in the 3,718 patients with polyvascular disease compared with the 12,059 patients with a single-territory atherothrombotic disease. Good risk factor control was associated with lower cardiovascular death/nonfatal stroke/nonfatal myocardial infarction (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.69-0.83) and mortality (OR, 0.89; 95% CI, 0.79-0.99) at 36 months, compared with poor control. Optimal cardiovascular risk factor control was associated with reduced mortality at 3 years, and a positive impact on 1-year, 2-year and 3-year cardiovascular event rates (i.e., fewer nonfatal cardiovascular events in polyvascular patients and both fatal and nonfatal events in patients with single-territory atherothrombotic disease). Independent predictors of good control of risk factors included residence in western versus eastern Europe (OR, 1.29), high level of education (OR, 1.16), established coronary artery disease (OR, 1.18), and treatment with one or more antithrombotic (OR, 1.59) and one or more lipid-lowering agent (OR, 1.16).

Conclusions:

In the REACH Registry, less than 60% of patients with stable atherothrombotic disease had good control of the five major cardiovascular risk factors. Improved risk factor control is associated with a positive impact on 3-year cardiovascular event rates and mortality.

Perspective:

This large observational study confirms the value of the evidence-based treatments, as identified in controlled trials in atherothrombotic disease. It will no doubt be used by the health care industry to encourage both patients and providers to follow guidelines. The benefits do not seem as robust as predicted from trials. An analysis of the advantage of achieving ‘optimal’ versus ‘good’ targets in the REACH Registry will be of value.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Cholesterol, Registries, Myocardial Infarction, Stroke, Health Care Sector, Coronary Disease, Risk Factors, Blood Pressure, Europe


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