Cited by 753Antiplatelet Therapy and Cardiovascular DiseasesAcute Myocardial Infarction ResearchAcute Ischemic Stroke Management

Comparative Determinants of 4-Year Cardiovascular Event Rates in Stable Outpatients at Risk of or With Atherothrombosis

Bhatt, Deepak L., Eagle, Kim A., Ohman, E. Magnus, Hirsch, Alan T., Goto, Shinya, Mahoney, Elizabeth M., Wilson, Peter W. F., Alberts, Mark J. +10 more·2010·JAMA

Abstract

CONTEXT: Clinicians and trialists have difficulty with identifying which patients are highest risk for cardiovascular events. Prior ischemic events, polyvascular disease, and diabetes mellitus have all been identified as predictors of ischemic events, but their comparative contributions to future risk remain unclear. OBJECTIVE: To categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors. DESIGN, SETTING, AND PATIENTS: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral arterial disease or with multiple risk factors for atherothrombosis were enrolled in the global Reduction of Atherothrombosis for Continued Health (REACH) Registry and were followed up for as long as 4 years. Patients from 3647 centers in 29 countries were enrolled between 2003 and 2004 and followed up until 2008. Final database lock was in April 2009. MAIN OUTCOME MEASURES: Rates of cardiovascular death, myocardial infarction, and stroke. RESULTS: A total of 45,227 patients with baseline data were included in this 4-year analysis. During the follow-up period, a total of 5481 patients experienced at least 1 event, including 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke, and 40 with both a myocardial infarction and stroke on the same day. Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n = 21,890) had the highest rate of subsequent ischemic events (18.3%; 95% confidence interval [CI], 17.4%-19.1%); patients with stable coronary, cerebrovascular, or peripheral artery disease (n = 15,264) had a lower risk (12.2%; 95% CI, 11.4%-12.9%); and patients without established atherothrombosis but with risk factors only (n = 8073) had the lowest risk (9.1%; 95% CI, 8.3%-9.9%) (P < .001 for all comparisons). In addition, in multivariable modeling, the presence of diabetes (hazard ratio [HR], 1.44; 95% CI, 1.36-1.53; P < .001), an ischemic event in the previous year (HR, 1.71; 95% CI, 1.57-1.85; P < .001), and polyvascular disease (HR, 1.99; 95% CI, 1.78-2.24; P < .001) each were associated with a significantly higher risk of the primary end point. CONCLUSION: Clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for outpatients with atherothrombosis.

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Crossref · 10.1001/jama.2010.1322

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Authors
Bhatt, D. L., Eagle, K. A., Ohman, E. M., Hirsch, A. T., Goto, S., Mahoney, E. M., Wilson, P. W. F., Alberts, M. J., D’Agostino, R., Liau, C.-S., Mas, J.-L., Röther, J., Smith, S. C., Salette, G., Contant, C. F., Massaro, J. M., Steg, P. G., & REACH Registry Investigators, F. T.
Affiliations
  • Brigham and Women's Hospital (US)
  • University of Michigan (US)
  • Duke University (US)
  • University of Minnesota (US)
  • Tokai University (JP)
  • Saint Luke's Hospital (US)
  • Emory University (US)
  • Northwestern University (US)
  • Boston University (US)
  • Tzu Chi Foundation (TW)
  • Université Paris Descartes (FR)
  • Asklepios Klinik St. Georg (DE)
  • Sanofi (France) (FR)
  • Thrombolysis in Myocardial Infarction Study Group (US)
Corresponding author
Bhatt, Deepak L.
Venue
JAMA
Published
2010-09-22
Volume
304
Issue
12
Pages
1350
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W2002189205
Cited by
753
References
23
Citations by year
2026: 23 · 2025: 31 · 2024: 41 · 2023: 43 · 2022: 52 · 2021: 66 · 2020: 62 · 2019: 71 · 2018: 59 · 2017: 59 · 2016: 56 · 2015: 40 · 2014: 32 · 2013: 48 · 2012: 38
FWCI
25.46
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
cardiovascular events, atherothrombosis, cardiovascular risk stratification, coronary artery disease, cerebrovascular disease, peripheral arterial disease, diabetes mellitus, cardiovascular mortality, myocardial infarction, stroke, REACH registry, stable outpatients, risk factors, polyvascular disease, risk prediction model
MeSH terms
Aged, Cardiovascular Diseases, Diabetes Mellitus, Female, Forecasting, Humans, Male, Middle Aged, Myocardial Infarction, Outpatients, Prognosis, Registries, Risk Factors, Thrombosis, Peripheral Vascular Diseases, Risk Assessment, Stroke, Atherosclerosis

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