reach registry slide kit - clinical trial results

Updated slide kit, February 2006

1

The REACH Registry

An International, Prospective Observational Study in Subjects at Risk of Atherothrombotic Events in an Outpatient Setting


2

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


3

Background


4

Burden of Disease


5

Stable angina

Thrombosis

1. Adapted from Libby P. Circulation 2001; 104: 365–372.2. Drouet L. Cerebrovasc Dis 2002; 13(Suppl 1): 1–6.

UA=unstable angina; MI=myocardial infarction; ACS=acute coronary syndrome; TIA=transient ischemic attack

UA MI

Ischemic stroke/TIA

Vascular death

ACS

Atherothrombosis – a Generalized and Progressive Disease Process1,2


6

Aggregation of platelets into

a thrombus

Platelets

Endothelial cells

Platelets adhering to subendothelial space

Platelet thrombus

Normal platelets in flowing blood

Platelets adhering to damaged endothelium

and undergoing activation

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.

Major Role of Platelets in Atherothrombosis1


7

Major Manifestations of Atherothrombosis1

1. Viles-Gonzalez JF. Eur Heart J 2004; 25: 1197–1207.

Coronary artery disease (CAD)

Cerebrovascular disease (Cerebrovasc Dis)

Peripheral arterial disease (PAD)


8

1. The World Health Report 2004. WHO Geneva, 2004. Available at: http://www.who.int/whr/2004/en/. Accessed January 2006.

29

19

13

9

7

5

0 5 10 15 20 25 30

Cardiovascular disease*

Infectious and parasitic diseases

Cancer

Injuries

Pulmonary disease

HIV/AIDS

Percentage of total deaths in 2002

*Ischemic heart disease, cerebrovascular disease, hypertensive heart disease, inflammatory heart disease and rheumatic heart disease

Cardiovascular Disease is the Leading Cause of Death Worldwide1


9

Analysis of data from the Framingham Heart Study:Average remaining life expectancy for males aged 60 years

Healthy History of any cardiovascular

disease*

History of acute MI

History of stroke

1. Peeters A et al. Eur Heart J 2002; 23: 458466.

*Including coronary heart disease, cerebrovascular accident, congestive heart failure and intermittent claudication

0

4

8

12

16

20

Tim

e (y

ears

)

9.2 years7.7 years 12.0 years

Atherothrombosis Significantly Shortens Life Expectancy1


10

Risk of Atherothrombosis


11

Cardiovasculardisease

Cerebrovascular disease

PAD

24.7%

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 rounding

A total of ~26% of patients had manifestations of atherothrombosis in

more than one arterial bed

26.2%†

1. Coccheri S. Eur Heart J 1998; 19(Suppl): 227.

Atherothrombosis is Often Found in More Than One Arterial Bed*1


12

Increased risk versus general population

MI Stroke

MI 5–7 X (includes death)3

3–4 X (includes TIA)1

Ischemic stroke 2–3 X (includes angina and sudden death*)1

9 X2

PAD 4 X (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. Kannel WB. J Cardiovasc Risk 1994; 1: 333–339.2. Wilterdink JI et al. Arch Neurol 1992; 49: 857–863.3. Adult Treatment Panel II. Circulation 1994; 89: 1333–1363.4. Criqui MH et al. N Engl J Med 1992; 326: 381–386.

Patients with Previous Atherothrombotic Events are at Increased Risk of Further Events


13

1. Bhatt DL et al. Am Heart J 2004; 140: 263–268.

Increased risk of atherothrombotic events

Independent 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 smoking>15 cigarettes/day

• Type 1 or 2diabetes

• Hypercholesterolemia• Diabetic nephropathy• Hypertension• ABI <0.9 in either

leg at rest• Asymptomatic carotid

stenosis 70%• Presence of at least

one carotid plaque


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*Risk factors: hypertension; hypercholesterolemia; dyslipidemia; diabetes; smoking; left ventricular hypertrophy

1. Kannel WB. Hypertens Res 1995; 18: 181–196.

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6

Estim

ated

10-

yea r

C

HD

rat e

(%)

Number of risk factors*

MenWomen

Risk of CHD Increased in Patients with Multiple Risk Factors1


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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): 8E11E. 2. Ferdinand KC et al. Curr Med Res Opin 2005; 21: 10911097.


16

REACH Registry: Background


17

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

1. Bhatt DL et al, on behalf of the REACH Registry Investigators.JAMA 2006; 295(2): 180-189.

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 criteria3. Been conducted in either North America or Europe


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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



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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

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

REACH Registry: Objectives1

1. Ohman EM et al, on behalf of the REACH Registry Investigators.Am Heart J 2006; in press.


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Improving the Management of Cardiovascular Disease Risk

Risk factor Recommendation

Blood pressure <140/90 mm Hg1,2 (<130/80 mm Hg for patients with diabetes13)

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 cessation13

Dietary intake An overall healthy eating pattern13

Physical activity Moderate intensity physical activity for 3045 minutes at least 35 times per week13

Weight management

Achieve and maintain desirable weight14 (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: 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.

Guideline recommendations by which REACH Registry patients are benchmarked


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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

What do we hope the REACH Registry will achieve?


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REACH Registry: Design


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*Timelines are for worldwide participation; local timelines will be shorter

Baseline Follow-up at 12 3 months

Follow-up at 24 3 months

REACH Registry extension


Timing* Dec 2003 to June 2004

From baseline time

Last follow-up March 2006

Sept 2006 to March 2007


Required Data

Subject Data Form:

Section 1

Subject Data Form: Section

2(progression

since baseline)

Subject Data Form: Section 3

(progression since lastfollow-up)





Patient details, history and

clinical examination

Regular medicationsEmployment

status

Clinical outcomesVascular interventionsRegular medicationsEmployment status

REACH Registry Timeline


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Must include:

Signedwritten

informedconsent

Patients aged≥45 years

At least of four criteria1

1. Documented cerebrovascular diseaseIschemic stroke or TIA

2. Documentedcoronary diseaseAngina, MI, angioplasty/stent/bypass

3. Documented historicalor current intermittentclaudication associatedwith ABI <0.9

4. At least atherothrombotic risk factors3

1. Male aged 65 yearsor female aged 70 years

2. Current smoking>15 cigarettes/day

3. Type 1 or 2diabetes

4. Hypercholesterolemia5. Diabetic nephropathy6. Hypertension7. ABI <0.9 in either

leg at rest8. Asymptomatic carotid

stenosis 70%9. Presence of at least

one carotid plaque

REACH Registry Inclusion Criteria1



26

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



27

Participating physicians

Pre-defined at start of Registry

Based on local practice population• General practitioners (GPs), specialists

Mainly office-based, some hospital representation

Representative of:• Local environment• Country geography

How were they selected?

What is their profile?


Physician Selection: Reflection of Each Country’s Management of Cardiovascular Risk1


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Patients

Recruitment at each site

Maximum per site determined at local level (subject to central guidelines)

Within overall Registry timelines

Patient inclusion criteria• Documented atherothrombotic disease, or with at least 3

atherothrombotic risk factors

Real-life setting

How were they selected?

What is their profile?


Patient Selection: Patients Fitting Inclusion Criteria1


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REACH Registry:Baseline Results

Data shown may differ slightly from published abstractsowing to a subsequent database lock


30

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



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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 medications1. 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 1127–1196.4. Röther J et al. International Stroke Conference 2005; late breaking abstract.


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Australia: 2,872

Latin America: 1,931Brazil: 441Chile: 253Mexico: 899Interlatina†: 338

Middle East: 846Israel: 379Kingdom of Saudi Arabia: 198Lebanon: 120United Arab Emirates: 149

Europe: 23,542Austria: 1,588 Lithuania: 99Belgium: 383 The Netherlands: 324Bulgaria: 996 Portugal: 218Denmark: 422 Romania: 2,009Finland: 311 Russia: 999France: 4,592 Spain: 2,515Germany: 5,521 Switzerland: 695Greece: 699 Ukraine: 596Hungary: 957 United Kingdom: 618

North America: 27,746Canada: 1,976USA: 25,770

Thailand: 515Taiwan: 1,057South Korea: 505Singapore: 880Philippines: 1,039Malaysia: 525

Indonesia: 499Hong Kong: 175China: 708Asia: 10,951

Japan: 5,048

†Interlatina includes Panama, Costa Rica, Dominican Republic, Ecuador, Guatemala and Peru

A Large and Far-Reaching International Survey of Atherothrombosis*1

*Data shown may differ slightly from published abstracts owing to a subsequent database lock.



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North AmericaEuropeAsia (incl. Japan)AustraliaLatin AmericaMiddle East

40.8%

2.8%

16.3%

4.2%

34.6%

1.2%

Geographic location of patients included in the initial analysis1


Broad Geographic Representation*1



34

70 67 6863 66 65

73 7062 65

7267

7467 66

74

0

20

40

60

80

100

NorthAmerica

(n=20,750)

LatinAmerica(n=1,681)

WesternEurope

(n=15,053)

EasternEurope

(n=5,375)

MiddleEast

(n=718)

Asia(n=5,137)

Australia(n=2,567)

Japan(n=4,218)

Mean age (years)Male (%)

*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.

Age and Gender of the Symptomatic Baseline Population*1


Age and Gender, Symptomatic Population(years, % of symptomatic population)1


35

4338 34

26

4941

25

39

8477 78

8581 80

7671

82

59

72

51

81

56

78

45

0

20

40

60

80

100

NorthAmerica

(n=20,750)

LatinAmerica(n=1,681)

WesternEurope

(n=15,053)

EasternEurope

(n=5,375)

MiddleEast

(n=718)

Asia(n=5,137)

Australia(n=2,567)

Japan(n=4,218)

Diabetes (%)Hypertension (%)Hypercholesterolemia (%)

Classic Cardiovascular Risk Factors are Consistent and Common within the Symptomatic REACH Registry Baseline Population*1


Risk Factor Prevalence, Symptomatic Population(% of symptomatic population)1

*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.


36

69 66 69 65 68 6773 70

4741

56

44

6150

5549

0

20

40

60

80

100

NorthAmerica(n=6,996)

LatinAmerica(n=250)

WesternEurope

(n=2,833)

EasternEurope(n=281)

MiddleEast

(n=128)

Asia(n=766)

Australia(n=305)

Japan(n=830)

Mean age (years)Male (%)


Age and Gender of the Multiple Risk Factor Population at Baseline*1


Age and Gender, Multiple Risk Factor Population(years, % of MRF population)1


37

77 8070

53

71

87 84 8793 89 92 94 94

8883

73

89

7177

68

8777

94

65

0

20

40

60

80

100

120

NorthAmerica(n=6,996)

LatinAmerica(n=250)

WesternEurope

(n=2,833)

EasternEurope(n=281)

MiddleEast

(n=128)

Asia(n=766)

Australia(n=305)

Japan(n=830)

Diabetes (%)Hypertension (%)Hypercholesterolemia (%)


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


38

43%

29%

13%

2% 1%9%

2%1%

General practitionersInternistsCardiologistsNeurologistsAngiologistsGeneral surgeonsEndocrinologistsOther expertise

REACH Registry Investigators by specialty (% of total)1



Primary Care Practitioners (GPs and internists) Formed the Majority of REACH Registry investigators


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High Prevalence of Polyvascular Disease(Disease in More Than One Arterial Bed)


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~ 1/4 of the 40,258 patients with CAD also have atherothrombotic disease in other arterial territories

~ 1/4 of Patients with CADHave Polyvascular Disease1


Coronary Artery Dis

Periph Art Disease

4.7%

8.4%

1.6% Cerebro-vascular

RISK FACTORS ONLY

44.6%

(%s are of total population)1

Patients with CAD = 59.3% of the REACH Registry population


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~ 2/5 of the 18,843 patients with Cerebrovascular Disease also haveatherothrombotic disease in other arterial territories

RISK FACTORS ONLY

8.4%

1.6%

1.2%

~ 2/5 of Patients with Cerebrovascular Disease Have Polyvascular Disease1


16.6%

Patients with Cerebrovasc Dis = 27.8% of the REACH Registry population


Coronary Artery Dis

Cerebro-vascular

Periph Art Disease


42

~ 3/5 of the 8,273 patients with PAD also haveatherothrombotic disease in other arterial territories

RISK FACTORS ONLY

1.2%4.7%

1.6%

~ 3/5 of Patients with Symptomatic PADHave Polyvascular Disease1

4.7%


Patients with PAD = 12.2% of the total REACH Registry

population


Coronary Artery Dis

Cerebro-vascular

Periph Art Disease


43

A Large Minority had Polyvascular Disease in the REACH Registry*1

1.61.2

4.78.4

4.716.6

44.6

18.3

15.9

65.9

0 10 20 30 40 50 60 70

Multiple Risk Factors

CAD + Cerebro + PADCerebro + PAD

CAD + PADCAD + Cerebro

OverallPolyvascular Disease

PAD AloneCerebro Alone

CAD AloneOverall

Single Arterial Bed

Patients (%)*Data shown may differ slightly from published abstracts owing to a subsequent database lock.


Prevalence of disease in arterial beds(% of total)1


44

Undertreatment of Patients with Atherothrombosis Worldwide


45

Undertreatment of Risk Factorsin Patients Worldwide*1

159

65 64

344344 43

17

40

28

5343

17

6048

21

56

15 13

52

24

7

56

0

20

40

60

80

100

Elevated bloodpressure (≥140/90 mm

Hg)

Elevated cholesterol(≥200 mg/dL)

Continued smoking (≥5cigarettes/d)

Patie

nts

not a

chie

ving

targ

et (%

)

North AmericaLatin AmericaWestern EuropeEastern EuropeMiddle EastAsiaAustraliaJapan



Patients not achieving target(% of regional population)1


46

1418 18

46

19

39

3024

44

36

19

28

0

10

20

30

40

50

60

CAD (n=40,258) Cerebrovasc Dis(n=18,843)

PAD (n=8,273) Multiple RiskFactors (n=12,389)

Patie

nts

not r

ecei

ving

pro

ven

ther

apy

(%)

Antiplatelets Lipid-lowering Statin


Established Therapies are Consistently Underused in All Patient Types*1


Patients not receiving therapy(% of subpopulation)1


47

*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

High Prevalence of Overweight and Obesity in Most Regions*1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NorthAmerica

LatinAmerica

WesternEurope

EasternEurope

MiddleEast

Asia Australia Japan

Perc

ent o

f pop

ulat

ion

BMI <25BMI 25-<30BMI 30-<35BMI 35-<40BMI ≥40


Variation of overweight and obesity in the symptomatic population**(% of regional population)1


48


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NorthAmerica

LatinAmerica

WesternEurope

EasternEurope

MiddleEast

Asia Australia Japan

Perc

ent o

f pop

ulat

ion

BMI <25BMI 25-<30BMI 30-<35BMI 35-<40BMI ≥40


Variation of Overweight and Obesity in theMultiple Risk Factor REACH Registry Population

(% of regional population)1

Overweight and Obesity Highly Prevalent in Multiple Risk Factor Patients in Most Regions*1


49

44.2

66.7

24.5

81.0

0

20

40

60

80

100

Diabetes Hypercholesterolemia Current smoker Hypertension

Patie

nts†

(%)

†Of the 8,273 patients with symptomatic PAD, the mean age was 69.2 years and 70.7% were male


High Prevalence of Concomitant Risk Factors in Patients with Symptomatic PAD*1


Prevalence of risk factors in the PAD population(% of subpopulation)1


50

97.485.6 82.5 80.9

94.181.8 82.2

61.3

92.481.7 85.6

70.0

0

20

40

60

80

100

Antihypertensives Antiplatelets Oral antidiabeticagents

Lipid-loweringtherapyPa

tient

s re

ceiv

ing

prov

en th

erap

y (%

)

CAD only population CVD only population PAD only population


PAD Patients are Less Likely than Other Patients to Use Established Therapies*1


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

Patients receiving established therapy(% of patients)1


51

80.3 77

38.329.9

13

83.3

58.2

37.4

23.7

14.3

81

66.7

44.2

23.8 24.5

0

20

40

60

80

100

Treatedhypertension

Treated hyper-cholesterolemia

Treated diabetes Obesity (BMI ≥30) Current smoker

Patie

nts

(%)

CAD only populationCVD only populationPAD only population

Risk factors are consistently found across all disease sub-populations*1



Risk Factor Prevalence, By Sub-Population(% of MRF population)1


52

REACH Registry: Today and Beyond


53

Publications to Date


54

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–

121Risk 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–

1196Worldwide data from 15,332 stroke patients in 2004 the REACH Registry

Röther J International Stroke Conference 2005; late

breaking abstractSecondary 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

Correct as of 16th February 2006


55

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

presentationRenal 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



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



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Upcoming Analyses and Data Availability

Preliminary 1-year results from participating countriesare available at: www.REACHRegistry.org


58

Main Outcomes as Registry Continues

Baseline Follow-up at 12 3 months

Follow-up at 24 3 months



Timing Dec 2003 to June 2004

From baseline time

Last follow-up March 2006



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


59

Accepted Abstracts

Title Lead author

Conference/Type

Better Guideline Compliance with Medical Therapy seen in Patients with Prior Coronary Revascularization : Results from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Cannon C ACC 2006Oral 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 2006Late-breaker

"Global" Risk Factors and Treatment Intensity in Elderly Patients with Atherosclerosis: The Experience of the International REACH Registry

Hirsch AT ACC 2006Poster

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



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Papers in Development (I)

Title Lead author Target journal1-Year Cardiovascular Event Rates in the REACH Registry International Cohort of Over 68,000 Stable Outpatients with Atherothrombosis

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

Renal insufficiency according to atherothrombosis location in the REACH Registry

Dumaine R, Montalescot G, YeoT-C, Chan J

TBC

The international morbidity and mortality of peripheral arterial disease: Insights from the REACH Registry

Hirsch AT TBC



61

Papers in Development (II)

Title Lead author Target journalSocio-economic status baseline article Wilson PWF TBCAnalysis of the intensity of prevention efforts (at baseline) in CAD patients

Cannon C TBC

CABG manuscript Ohman EM TBCThe risk of abdominal aortic aneurysms: The REACH Registry

Baumgartner I TBC

1-year outcomes in CAD patients Eagle K TBChs-CRP in CAD Cannon C,

Zeymer UTBC

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



62

Participating Organizations and Scientific Committees


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Scientific Committee1

1. REACH Registry website. Available at: http://www.REACHRegistry.org. Accessed January 2006.

Name AffiliationP 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, USAJoachim Röther, MD, PhD Klinikum Minden, Minden, Germany

Peter WF Wilson, MD Medical University of South Carolina, Charleston, SC, USA


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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



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National Coordinators (I)1

Country Name and affiliationAustralia Christopher Reid, Monash University, VictoriaAustria Franz Aichner, Landes-Nervenklinik Wagner-Jauregg, Linz

Thomas Wascher, Medizinische Universitätsklinik, GrazBelgium Patrice Laloux, Cliniques Universitaires UCL, Mont-GodinneBrazil Denilson Campos de Albuquerque, State University of Rio de Janeiro, Rio de JaneiroBulgaria Julia Djorgova, University Hospital St Ekaterina, SofiaCanada Eric A Cohen, Sunnybrook & Women’s College Health Sciences Center, Toronto, OntarioChile Ramon Corbalan, Hospital Clinico Pontificia Universidad Catolica de Chile, SantiagoChina Chuanzhen LV, Shanghai Huashan Hospital, Shanghai

Runlin Gao, Fu Wai Hospital, BeijingDenmark Per Hildebrandt, H.S. Frederiksberg Hospital, FrederiksbergFinland Ilkka Tierala, Helsinki University Hospital, HelsinkiFrance Jean-Louis Mas, Hôpital Saint-Anne, Paris

Patrice Cacoub, Groupe Hospitalier Universitaire Pitié Salpétrière, ParisGilles Montalescot, Groupe Hospitalier Universitaire Pitié Salpétrière, Paris

Germany Klaus Parhofer, Universitätsklinikum Großhadern, MunichUwe Zeymer, Klinikum Ludwigshafen Medizinische, LudwigshafenJoachim Röther, Klinikum Minden, Minden



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National Coordinators (II)1

Country Name and affiliationGreece Moses Elisaf, University of Ioannina Medical School, IoanninaGuatemala Romulo López, Centro Diagnostico, Cuidad de GuatemalaHong Kong Juliana Chan, Prince of Wales Hospital, ShatinHungary György Pfliegler, University of Debrecen Medical and Health Science Center, DebrecenIndonesia Bambang Sutrisna, University of Indonesia, JakartaIsrael Avi Porath, Soroka Medical Center, Beer ShevaJapan Yasou Ikeda, Keio University School of Medicine, TokyoLebanon Ismail Khalil, American University Hospital Hamra, BeirutLithuania Ruta Babarskiene, University Hospital, KaunasMalaysia Robaayah Zambahari, Institut Jantung Negara, Kuala LumpurMexico Efrain Gaxiola, Instituto Cardiovascular de Guadalajara, JaliscoThe Netherlands Don Poldermans, Erasmus Medisch Centrum, RotterdamPhilippines M. Teresa B. Abola, Philippine Heart Center, Quezon CityPortugal Victor Gil, Hospital Fernando Fonseca, AmadoraRomania Constantin Popa, Institutul de Boli Cerebro-Vasculare, BucharestRussia Yuri Belenkov, Cardiology Research Complex, Moscow

Elizaveta Panchenko, Cardiology Research Complex, Moscow



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National Coordinators (III)1

Country Name and affiliationSaudi Arabia Hassan Chamsi-Pasha, King Fahd Military Hospital, JeddahSingapore Yeo Tiong Cheng, National University Hospital, SingaporeSouth Korea Oh Dong-Joo, Korea Hospital, SeoulSpain Carmen Suárez, Hospital Universitario de la Princesa, MadridSwitzerland Iris Baumgartner, Universitätspital Bern, BernTaiwan Chiau-Suong Liau, National Taiwan University Hospital, TaipeiThailand Piyamitr Sritara, Ramathibodi Hospital, BangkokUnited Arab Emirates

Wael Mahameed, Al Jazeera Hospital, Abu Dhabi

UK Jonathan Morrell, The Conquest Hospital, HastingsUkraine Vira Tseluyko, Kharkov Medical Academy of Postgraduate Education, KharkovUSA Mark Alberts, Northwestern University Medical Center, Chicago, IL

Robert M. Califf, Duke University Medical Center, Durham, NCChristopher P. Cannon, Brigham and Women’s Hospital, Boston, MAKim Eagle, University of Michigan Cardiovascular Center, Ann Arbor, MIAlan T Hirsch, Minneapolis Heart Institute Foundation and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN



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Participating Organizations

The REACH Registry is sponsored jointly by


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REACH Registry: Further Information

For further information on the REACH Registry go to:

http://www.REACHRegistry.org

reach registry slide kit - clinical trial results

Documents