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Deepak L. Bhatt, MD; P. Gabriel Steg, MD; E. Magnus Ohman, MD; Alan T. Hirsch, MD; Yasuo Ikeda, MD; Jean-Louis Mas, MD; Shinya Goto, MD; Chiau-Suong Liau, MD, PhD; Alain J. Richard, MD, PhD; Joachim Röther, MD; Peter W. F. Wilson, MD; for the REACH Registry Investigators

JAMA. 2006;295:180-189.

Context  Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis.

Objective  To determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world.

Design, Setting, and Participants  The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67 888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40 258; cerebrovascular disease, n = 18 843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12 389) between 2003 and 2004.

Main Outcome Measures  Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control.

Results  Atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P<.001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for 3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease.

Conclusion  This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.

Author Affiliations: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Bhatt); Departement de Cardiologie, Hôpital Bichat-Claude Bernard, Paris, France (Dr Steg); Division of Cardiology, Duke University, Durham, NC (Dr Ohman); Minneapolis Heart Institute Foundation and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (Dr Hirsch); Division of Hematology, Keio University School of Medicine, Tokyo, Japan (Dr Ikeda); Service de Neurologie, Centre Raymond Garcin, Hôpital Sainte-Anne, Paris, France (Dr Mas); Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan (Dr Goto); Department of Internal Medicine, National Taiwan University Hospital and School of Medicine, Taipei, Taiwan (Dr Liau); Global Medical Affairs–Clinical Operations, Sanofi-Aventis, Paris, France (Dr Richard); Department of Neurology, Klinikum Minden, Minden, Germany (Dr Röther); and General Clinical Research Center, Medical University of South Carolina, Charleston (Dr Wilson).

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