REACHRegistrybaselineslidekit(final)

Updatedslidekit,February20061TheREACHRegistryAnInternational,ProspectiveObservationalStudyinSubjectsatRiskofAtherothromboticEventsinanOutpatientSettingUpdatedslidekit,February20062OutlineBackground•BurdenofDisease•RiskofAtherothrombosisREACHRegistryBackground•RationaleandObjectives•DesignREACHRegistryBaselineResults•HighPrevalenceofPolyvascularDisease•UndertreatmentofPatientswithAtherothrombosisWorldwideREACHRegistryTodayandBeyond•PublicationstoDate•UpcomingAnalysesandDataAvailability•ParticipatingOrganizationsandScientificCommitteesUpdatedslidekit,February20063BackgroundUpdatedslidekit,February20064BurdenofDiseaseUpdatedslidekit,February20065StableanginaThrombosis1.AdaptedfromLibbyP.Circulation2001;104:365–372.2.DrouetL.CerebrovascDis2002;13(Suppl1):1–6.UA=unstableangina;MI=myocardialinfarction;ACS=acutecoronarysyndrome;TIA=transientischemicattackUAMIIschemicstroke/TIAVasculardeathACSAtherothrombosis–aGeneralizedandProgressiveDiseaseProcess1,2Updatedslidekit,February20066AggregationofplateletsintoathrombusPlateletsEndothelialcellsPlateletsadheringtosubendothelialspacePlateletthrombusNormalplateletsinflowingbloodPlateletsadheringtodamagedendotheliumandundergoingactivationSubendothelialspace1.Adaptedfrom:FergusonJJ.In:FergusonJJ,ChronosN,HarringtonRA(Eds).AntiplateletTherapyinClinicalPractice.London:MartinDunitz;2000:15–35.MajorRoleofPlateletsinAtherothrombosis1Updatedslidekit,February20067MajorManifestationsofAtherothrombosis11.Viles-GonzalezJF.EurHeartJ2004;25:1197–1207.Coronaryarterydisease(CAD)Cerebrovasculardisease(CerebrovascDis)Peripheralarterialdisease(PAD)Updatedslidekit,February200681.TheWorldHealthReport2004.WHOGeneva,2004.Availableat:*InfectiousandparasiticdiseasesCancerInjuriesPulmonarydiseaseHIV/AIDSPercentageoftotaldeathsin2002*Ischemicheartdisease,cerebrovasculardisease,hypertensiveheartdisease,inflammatoryheartdiseaseandrheumaticheartdiseaseCardiovascularDiseaseistheLeadingCauseofDeathWorldwide1Updatedslidekit,February20069AnalysisofdatafromtheFraminghamHeartStudy:Averageremaininglifeexpectancyformalesaged60yearsHealthyHistoryofanycardiovasculardisease*HistoryofacuteMIHistoryofstroke1.PeetersAetal.EurHeartJ2002;23:458466.*Includingcoronaryheartdisease,cerebrovascularaccident,congestiveheartfailureandintermittentclaudication048121620Time(years)9.2years7.7years12.0yearsAtherothrombosisSignificantlyShortensLifeExpectancy1Updatedslidekit,February200610RiskofAtherothrombosisUpdatedslidekit,February200611CardiovasculardiseaseCerebrovasculardiseasePAD24.7%3.8%11.8%29.9%3.3%7.4%19.2%*DatafromtheClopidogrelversusAspirininPatientsatRiskofIschemicEvents(CAPRIE)study(n=19,185)†TotaldoesnotaddupbecauseofroundingAtotalof~26%ofpatientshadmanifestationsofatherothrombosisinmorethanonearterialbed26.2%†1.CoccheriS.EurHeartJ1998;19(Suppl):227.AtherothrombosisisOftenFoundinMoreThanOneArterialBed*1Updatedslidekit,February200612IncreasedriskversusgeneralpopulationMIStrokeMI5–7X(includesdeath)33–4X(includesTIA)1Ischemicstroke2–3X(includesanginaandsuddendeath*)19X2PAD4X(includesonlyfatalMIandotherCHDdeath†)42–3X(includesTIA)2*Suddendeathdefinedasdeathdocumentedwithinonehourandattributedtocoronaryheartdisease(CHD)†IncludesonlyfatalMIandotherCHDdeath;doesnotincludenon-fatalMI1.KannelWB.JCardiovascRisk1994;1:333–339.2.WilterdinkJIetal.ArchNeurol1992;49:857–863.3.AdultTreatmentPanelII.Circulation1994;89:1333–1363.4.CriquiMHetal.NEnglJMed1992;326:381–386.PatientswithPreviousAtherothromboticEventsareatIncreasedRiskofFurtherEventsUpdatedslidekit,February2006131.BhattDLetal.AmHeartJ2004;140:263–268.IncreasedriskofatherothromboticeventsIndependentriskfactors:RiskFactorscanCreateHighRiskofMIandStroke,EvenWithNoHistoryofTheseEvents1•Maleaged65yearsorfemaleaged70years•Currentsmoking15cigarettes/day•Type1or2diabetes•Hypercholesterolemia•Diabeticnephropathy•Hypertension•ABI0.9ineitherlegatrest•Asymptomaticcarotidstenosis70%•PresenceofatleastonecarotidplaqueUpdatedslidekit,February200614*Riskfactors:hypertension;hypercholesterolemia;dyslipidemia;diabetes;smoking;leftventricularhypertrophy1.KannelWB.HypertensRes1995;18:181–196.0102030405060700123456Numberofriskfactors*MenWomenRiskofCHDIncreasedinPatientswithMultipleRiskFactors1Updatedslidekit,February200615ManyRiskFactorsareEasilyIdentified1,2RiskfactorMonitoringmethodDiabetesFastingbloodglucoselevelsLowABIABImeasurementCarotidarteryintima-mediathickness(IMT)DopplerultrasonographyHypertensionBloodpressureHypercholesterolemiaCholesteroltestingMicroalbuminuriaUrinealbuminconcentrationsWeightBodymassindex(BMI)1.GrundySM.AmJCardiol2001;88(Suppl):8E11E.2.FerdinandKCetal.CurrMedResOpin2005;21:10911097.Updatedslidekit,February200616REACHRegistry:BackgroundUpdatedslidekit,February200617REACHRegistry:RationaleandObjectivesUpdatedslidekit,February200618REACHRegistry:aGlobalObservationalStudyofaround68,000Patientsin44CountriesWhoAreatHighRiskofAtherothrombosis11.BhattDLetal,onbehalfoftheRE