1、Updated slide kit,February 20061The REACH RegistryAn International,Prospective Observational Study in Subjects at Risk of Atherothrombotic Events in an Outpatient SettingUpdated slide kit,February 20062OutlineBackgroundBurden of DiseaseRisk of AtherothrombosisREACH Registry BackgroundRationale and O
2、bjectivesDesignREACH Registry Baseline ResultsHigh Prevalence of Polyvascular DiseaseUndertreatment of Patients with Atherothrombosis WorldwideREACH Registry Today and BeyondPublications to DateUpcoming Analyses and Data AvailabilityParticipating Organizations and Scientific CommitteesUpdated slide
3、kit,February 20063BackgroundUpdated slide kit,February 20064Updated slide kit,February 20065Updated slide kit,February 20066Aggregation of platelets intoa thrombus PlateletsEndothelial cellsPlatelets adhering to subendothelial spacePlatelet thrombusNormal platelets in flowing bloodPlatelets adhering
4、 to damaged endothelium and undergoing activationSubendothelial space1.Adapted from:Ferguson JJ.In:Ferguson JJ,Chronos N,Harrington RA(Eds).Antiplatelet Therapy in Clinical Practice.London:Martin Dunitz;2000:1535.Major Role of Platelets in Atherothrombosis1Updated slide kit,February 20067Major Manif
5、estations of Atherothrombosis11.Viles-Gonzalez JF.Eur Heart J 2004;25:11971207.Coronary artery disease(CAD)Cerebrovascular disease(Cerebrovasc Dis)Peripheral arterial disease(PAD)Updated slide kit,February 200681.The World Health Report 2004.WHO Geneva,2004.Available at:http:/www.who.int/whr/2004/en
6、/.Accessed January 2006.291913975051015202530Cardiovascular disease*Infectious and parasitic diseasesCancerInjuriesPulmonary diseaseHIV/AIDSPercentage of total deaths in 2002*Ischemic heart disease,cerebrovascular disease,hypertensive heart disease,inflammatory heart disease and rheumatic heart dise
7、ase Cardiovascular Disease is the Leading Cause of Death Worldwide1Updated slide kit,February 20069Analysis of data from the Framingham Heart Study:Average remaining life expectancy for males aged 60 yearsHealthyHistory of any cardiovascular disease*History of acute MIHistory of stroke1.Peeters A et
8、 al.Eur Heart J 2002;23:458466.*Including coronary heart disease,cerebrovascular accident,congestive heart failure and intermittent claudication048121620Time(years)9.2 years 7.7 years 12.0 yearsAtherothrombosis Significantly Shortens Life Expectancy1Updated slide kit,February 200610Risk of Atherothr
9、ombosisUpdated slide kit,February 200611CardiovasculardiseaseCerebrovascular diseasePAD24.7%3.8%11.8%29.9%3.3%7.4%19.2%*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 roundingA total of 26%of patients had manifes
10、tations of atherothrombosis in more than one arterial bed26.2%1.Coccheri S.Eur Heart J 1998;19(Suppl):227.Atherothrombosis is Often Found in More Than One Arterial Bed*1Updated slide kit,February 200612Increased risk versus general populationMIStrokeMI57 X(includes death)334 X(includes TIA)1Ischemic
11、 stroke23 X(includes angina and sudden death*)19 X2PAD4 X(includes only fatal MI and other CHD death)423 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 MIKann
12、el WB.J Cardiovasc Risk 1994;1:333339.Wilterdink JI et al.Arch Neurol 1992;49:857863.Adult Treatment Panel II.Circulation 1994;89:13331363.Criqui MH et al.N Engl J Med 1992;326:381386.Patients with Previous Atherothrombotic Events are at Increased Risk of Further EventsUpdated slide kit,February 200
13、6131.Bhatt DL et al.Am Heart J 2004;140:263268.Increased risk of atherothrombotic eventsIndependent risk factors:Risk Factors can Create High Risk of MI and Stroke,Even With No History of These Events1 Male aged 65 yearsor female aged 70 years Current smoking15 cigarettes/day Type 1 or 2diabetes Hyp
14、ercholesterolemia Diabetic nephropathy Hypertension ABI 0.9 in eitherleg at rest Asymptomatic carotidstenosis 70%Presence of at leastone carotid plaqueUpdated slide kit,February 200614*Risk factors:hypertension;hypercholesterolemia;dyslipidemia;diabetes;smoking;left ventricular hypertrophy1.Kannel W
15、B.Hypertens Res 1995;18:181196.0102030405060700123456Estimated 10-year CHD rate(%)Number of risk factors*MenWomenRisk of CHD Increased in Patients with Multiple Risk Factors1Updated slide kit,February 200615Many Risk Factors are Easily Identified1,2Risk factorMonitoring methodDiabetesFasting blood g
16、lucose levelsLow ABIABI measurementCarotid artery intima-media thickness(IMT)Doppler ultrasonographyHypertensionBlood pressureHypercholesterolemiaCholesterol testingMicroalbuminuriaUrine albumin concentrationsWeightBody mass index(BMI)1.Grundy SM.Am J Cardiol 2001;88(Suppl):8E11E.2.Ferdinand KC et a
17、l.Curr Med Res Opin 2005;21:10911097.Updated slide kit,February 200616REACH Registry:BackgroundUpdated slide kit,February 200617REACH Registry:Rationale and ObjectivesUpdated slide kit,February 200618REACH Registry:a Global Observational Study of around 68,000 Patients in 44 Countries Who Are at Hig
18、h Risk of Atherothrombosis11.Bhatt DL et al,on behalf of the REACH Registry Investigators.JAMA 2006;295(2):180-189.RationaleEvaluation of atherothrombosis is still limited because previous surveys have:Focused on studying specific risk factors,or single manifestations of the disease(e.g.heart diseas
19、e)Focused mostly on hospitalized or hospital-treated patients with stringent inclusion criteria1.Been conducted in either North America or EuropeUpdated slide kit,February 200619REACH Registry:a Global Observational Study of around 68,000 Patients in 44 Countries Who Are at High Risk of Atherothromb
20、osis1The REACH Registry should have these added advantages:The most globally inclusive and geographically extensive registry of patients at high risk of heart attack and strokeIncludes a broad spectrum of patient types with or without a previous history of diseaseProvides data from a real world sett
21、ing,reflecting daily practice1.Bhatt DL et al,on behalf of the REACH Registry Investigators.JAMA 2006;295(2):180-189.Updated slide kit,February 200620Primary objectives are:Compile international data set to extend knowledge of atherothrombotic risk factors and ischemic events in the outpatient setti
22、ngProvide a better understanding of the prevalence and clinical consequences of atherothrombosis in a wide range of patients from different parts of the worldImportant intermediate investigations have included:Assess use of risk management strategies and 18-to 24-month outcomes in a broad outpatient
23、 population encompassing various geographic regions and physician specialtiesREACH Registry:Objectives11.Ohman EM et al,on behalf of the REACH Registry Investigators.Am Heart J 2006;in press.Updated slide kit,February 200621Improving the Management of Cardiovascular Disease RiskRisk factorRecommenda
24、tionBlood pressure140/90 mm Hg1,2(130/80 mm Hg for patients with diabetes13)Total cholesterol200 mg/dL/11.1 mmol/L14Triglyceride150 mg/dL(1.7 mmol/L)3,4Diabetes managementNormal 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)SmokingComplete cessation13D
25、ietary intakeAn overall healthy eating pattern13Physical activityModerate intensity physical activity for 3045 minutes at least 35 times per week13Weight managementAchieve and maintain desirable weight14(BMI 18.524.9 kg/m2).1 When BMI is 25 kg/m2,waist circumference at iliac crest level 102 cm(40 in
26、ches)in men and 88 cm(35 inches)in women1,21.Pearson TA et al.Circulation 2002;106:388391.2.De Backer G et al.Eur Heart J 2003;24:16011610.3.American Diabetes Association.Diabetes Care 2005;28:S4S36.4.Adult Treatment Panel III.National Institutes of Health,Publication No.02-5215,September 2002.Guide
27、line recommendations by which REACH Registry patients are benchmarkedUpdated slide kit,February 200622REACH 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
28、 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 factorsWhat do we hop
29、e the REACH Registry will achieve?Updated slide kit,February 200623REACH Registry:DesignUpdated slide kit,February 200624*Timelines are for worldwide participation;local timelines will be shorterBaselineFollow-up at 12 3 monthsFollow-up at 24 3 monthsREACH Registry extensionREACH Registry extensionT
30、iming*Dec 2003 to June 2004From baseline timeLast follow-up March 2006Sept 2006 to March 2007Sept 2007 to March 2008Required DataSubject Data Form:Section 1Subject Data Form:Section 2(progression since baseline)Subject Data Form:Section 3(progression since lastfollow-up)Subject Data Form:Section 4(p
31、rogression since lastfollow-up)Subject Data Form:Section 5(progression since lastfollow-up)Patient details,history and clinical examinationRegular medicationsEmployment statusClinical outcomesVascular interventionsRegular medicationsEmployment statusREACH Registry TimelineUpdated slide kit,February
32、200625Must include:SignedwritteninformedconsentPatients aged45 years At least of four criteria1 Documented cerebrovascular diseaseIschemic stroke or TIA Documentedcoronary diseaseAngina,MI,angioplasty/stent/bypass Documented historicalor current intermittentclaudication associatedwith ABI 15 cigaret
33、tes/day Type 1 or 2diabetes Hypercholesterolemia Diabetic nephropathy Hypertension ABI 48,000 patients from the international REACH RegistryWilson PWEur Heart J 2005;26(Suppl):Abstract 447Comparison of risk factors between stroke and transient ischemic attack patients:observations from the internati
34、onal REACH RegistryRther JWorld Congress of Neurology 2005 oral presentationRenal insufficiency is frequent and undertreated among outpatients at high risk of atherothrombotic events:lessons from the REACH Registry Dumaine RAHA 2005 oral presentationQuality of secondary prevention:a comparison betwe
35、en stroke and transient ischemic attack(TIA)patients Rther JAHA-Stroke 2006 poster presentationCorrect as of 16th February 2006Updated slide kit,February 200656REACH Registry Publications PapersTitleLead authorCitationAtherothrombosis and stroke-a lot more to know!Rther JCerebrovasc Dis 2005;20(2):1
36、39-40Estimating the risk for atherothrombosis are current algorithms sufficient?Wilson PEur J Cardiovasc Prev Rehabil 2005;12(5):427-32The REduction of Atherothrombosis for Continued Health(REACH)Registry:An international,prospective,observational investigation in subjects at risk for atherothrombot
37、ic events study designOhman EMAm Heart J 2006;In PressInternational prevalence,recognition,and treatment of cardiovascular risk factors in outpatients with atherothrombosisBhatt DJAMA 2006;295(2):180-9Correct as of 16th February 2006Updated slide kit,February 200657Upcoming Analyses and Data Availab
38、ilityPreliminary 1-year results from participating countriesare available at:www.REACHRegistry.orgUpdated slide kit,February 200658Main Outcomes as Registry ContinuesBaselineFollow-up at 12 3 monthsFollow-up at 24 3 monthsREACH Registry extensionREACH Registry extensionTimingDec 2003 to June 2004Fro
39、m baseline timeLast follow-up March 2006Sept 2006 to March 2007Sept 2007 to March 2008Forthcoming analyses will examine:Combined endpoint of cardiovascular death,nonfatal stroke,nonfatal MI,vascular interventions and hospitalizations for atherothrombotic eventsCombined endpoint of nonfatal stroke,no
40、nfatal MI and cardiovascular deathIndividual 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 ischemiaUpdated slide kit,February 200659Accepted Abstrac
41、tsTitleLead authorConference/TypeBetter Guideline Compliance with Medical Therapy seen in Patients with Prior Coronary Revascularization:Results from the REduction of Atherothrombosis for Continued Health(REACH)RegistryCannon CACC 2006Oral presentationREduction in Atherothrombosis for Continued Heal
42、th(REACH)Registry results:1-year cardiovascular event rates in a global contemporary registry of over 68,000 outpatients with atherothrombosisSteg PGACC 2006Late-breakerGlobal Risk Factors and Treatment Intensity in Elderly Patients with Atherosclerosis:The Experience of the International REACH Regi
43、stry Hirsch ATACC 2006PosterRisk factor control among patients with diabetes mellitus in Europe and the rest of the world:the experience of the REACH RegistryWilson PWCVDEP 2006(AHA-Epi 2006)PosterCorrect as of 16th February 2006Updated slide kit,February 200660Papers in Development(I)TitleLead auth
44、orTarget journal1-Year Cardiovascular Event Rates in the REACH Registry International Cohort of Over 68,000 Stable Outpatients with Atherothrombosis Steg PGJAMARisk factor profile and management of 18,984 patients in 2004,the REACH Registry-an international prospective observational registry in subj
45、ects at risk of atherothrombotic events in an outpatient settingRoether J,Mas J-LStroke TBCRisk of vascular death and myocardial infarction in patients with stroke or TIA:Results from the REduction of Atherothrombosis for Continued Health(REACH)RegistryMas J-LTBCRenal insufficiency according to athe
46、rothrombosis location in the REACH RegistryDumaine R,Montalescot G,YeoT-C,Chan JTBCThe international morbidity and mortality of peripheral arterial disease:Insights from the REACH RegistryHirsch ATTBCCorrect as of 16th February 2006Updated slide kit,February 200661Papers in Development(II)TitleLead
47、authorTarget journalSocio-economic status baseline articleWilson PWFTBCAnalysis of the intensity of prevention efforts(at baseline)in CAD patientsCannon CTBCCABG manuscriptOhman EMTBCThe risk of abdominal aortic aneurysms:The REACH RegistryBaumgartner ITBC1-year outcomes in CAD patientsEagle KTBChs-
48、CRP in CADCannon C,Zeymer UTBCCardiovascular morbidity of severe peripheral arterial disease:the fate of individuals with ischemic amputations in the REACH RegistryAbola MTBTBCBaseline control of risk factors according to surgical or medical management of PAD patients in the REACH RegistryCacoub PTB
49、CCorrect as of 16th February 2006Updated slide kit,February 200662Participating Organizations and Scientific CommitteesUpdated slide kit,February 200663Scientific Committee11.REACH Registry website.Available at:http:/www.REACHRegistry.org.Accessed January 2006.NameAffiliationP Gabriel Steg,MDHpital
50、Bichat-Claude Bernard,Paris,France(Co-chair)Deepak L Bhatt,MDCleveland Clinic Foundation,Cleveland,OH,USA(Co-chair)E Magnus Ohman,MDDuke University Medical Center,Durham,NC,USAJoachim Rther,MD,PhDKlinikum Minden,Minden,GermanyPeter WF Wilson,MDMedical University of South Carolina,Charleston,SC,USAUp
